Appeals & Grievances Specialist – Health Plan

CVS Health; Tallahassee (FL); Presencial; USD 23.000 - 43.000; Jornada completa

Descripción de la vacante

CVS Health is seeking a detail-oriented Appeals Specialist to manage intake, research and resolution of member and provider appeals, complaints, and grievances. You will coordinate responses across multiple teams, verify eligibility and benefit details, and ensure timely communication to members.

Strong analytical and regulatory knowledge is required to identify trends and support quality service. The role emphasizes accuracy, collaboration, and the ability to work in a fast-paced environment

Formación

• Experience in reading or researching benefit language.
• 1-2 years experience across claim platforms, products and benefits; patient management; compliance and regulatory analysis.

Responsabilidades

• Triage and investigate appeals, complaints and grievances for multiple products.
• Coordinate responses across business units and ensure timely resolution.
• Identify trends and emerging issues and report to stakeholders.
• Serve as a technical resource on appeals, complaints and grievance issues.
• Maintain high-paced turnaround times and accurate documentation.

Conocimientos

Benefit language reading

Claim platform experience

Regulatory analysis

Customer service

Educación

Some college

High School or GED equivalent

Descripción del empleo

CVS Health is seeking a detail-oriented Appeals Specialist to manage intake, research and resolution of member and provider appeals, complaints, and grievances. You will coordinate responses across multiple teams, verify eligibility and benefit details, and ensure timely communication to members.

Strong analytical and regulatory knowledge is required to identify trends and support quality service. The role emphasizes accuracy, collaboration, and the ability to work in a fast-paced environment