Complaint and Appeals Analyst - Fully Remote

Lensa; Sacramento (CA); Remote; USD 80,000 - 100,000; Full time

Job summary

Lensa is seeking a Complaint and Appeals Analyst for CVS Health. This fully remote position requires processing grievances and appeals, with a focus on Medicare and Medicaid. Ideal candidates will have experience in health insurance processes and a high school diploma. The role offers competitive pay, benefits, and a supportive work environment.

Benefits

Affordable medical plans

401(k) with matching

Employee stock purchase plan

Flexible work schedules

Paid time off

Tuition assistance

Qualifications

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

Be among the first 25 applicants one day ago.

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 more connected, more convenient, and more compassionate. 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, Nurses, and Leadership.

Required Qualifications

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

Preferred Qualifications

• 6+ years of experience with Medicare and Medicaid appeal and grievance processes.

Education

• High School Diploma or GED required.

Additional Details

• Anticipated weekly hours: 40
• Employment type: Full-time
• Pay range: $21.10 - $44.99 per hour

Our people fuel our future. We are committed to fostering a workplace where every colleague feels valued and belongs.

Benefits

We offer a comprehensive and competitive mix of pay and benefits, including:

• Affordable medical plans, 401(k) with matching, employee stock purchase plan.
• No-cost wellness programs, counseling, financial coaching.
• Flexible work schedules, paid time off, family leave, tuition assistance, and more.

For more information, visit CVS Health Benefits.

Application deadline: 06/04/2025.

We consider qualified applicants with arrest or conviction records in accordance with applicable laws. We are an equal opportunity employer, committed to diversity and inclusion.

Additional Information

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Business Development and Sales
• Industries: IT Services and IT Consulting