Complaint and Appeals Analyst - Fully Remote

Lensa; Carson City (NV); Remote; Full time

Job summary

A leading health solutions company is seeking a Complaint and Appeals Analyst to handle grievances and appeals for Dual eligible members. The role involves interaction with Medical Directors and Nurses, requiring a strong background in health insurance processing. Join a team dedicated to transforming healthcare with compassion.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings and counseling

Tuition assistance

Qualifications

• 1 year of experience processing health insurance grievance and appeal cases.
• 6+ years of experience Medicare and Medicaid appeal and grievance preferred.

Responsibilities

• Research and process grievances and appeals for Dual eligible members and providers.
• Perform outreach to obtain additional information.

Skills

Health Insurance Processing

Education

High School Diploma or GED

Job description

Complaint and Appeals Analyst - Fully Remote

Complaint and Appeals Analyst - Fully Remote

1 day ago Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, CVS Health, is seeking professionals. Apply via Lensa today!

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

• 6+ years of experience Medicare and 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: 06/04/2025

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.

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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