Complaint and Appeals Analyst - Fully Remote

Lensa; Atlanta (GA); Remote; USD 80,000 - 100,000; Full time

Job summary

Lensa is seeking a Complaint and Appeals Analyst to work fully remote. In this role, you’ll process grievances and appeals for health care members, requiring a high school diploma and experience in health insurance. Join a leading company where you’ll contribute to transforming health care and make a difference in people's lives.

Benefits

Affordable medical plan options

401(k) plan with company matching

Paid time off and flexible work schedules

Tuition assistance

Qualifications

• 1 year of experience processing health insurance grievance and appeal cases required.
• Experience with Medicare and/or Medicaid appeal preferred.

Responsibilities

• Research and process grievances and appeals for Dual eligible members and providers.
• Interact with Medical Directors and Nurses.

Skills

Processing health insurance grievance and appeal cases

Outreach to obtain additional information

Education

High School Diploma or GED

Job description

Complaint and Appeals Analyst - Fully Remote

Complaint and Appeals Analyst - Fully Remote

2 days ago Be among the first 25 applicants

Lensa partners with DirectEmployers to promote this job for CVS Health.

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Research and process grievances and appeals for Dual eligible members and providers. Perform outreach to obtain additional information. Interact with Medical Directors and Nurses as well as Leadership.

Required Qualifications

• 1 year of experience processing health insurance grievance and appeal cases.
  
  

Preferred Qualifications

• 2+ years of experience with Medicare and/or Medicaid appeal and grievance preferred.
  
  

Education

• High School Diploma or GED required
  
  

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is

$21.10 - $44.99

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great Benefits For Great People

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan .
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
  
  

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 07/03/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

If you have questions about this posting, please contact [e-mail]

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Business Development and Sales

• Industries

  IT Services and IT Consulting

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