Complaint and Appeals Analyst - Fully Remote

CVS Health; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

CVS Health is seeking a dedicated individual to research and process grievances and appeals related to health insurance for Dual eligible members. This full-time role involves significant interaction with healthcare professionals and requires prior experience in grievance processing. Ideal candidates will possess a High School Diploma or GED and have up to 2 years of Medicare/Medicaid experience. With competitive pay and a commitment to employee well-being, CVS Health offers a supportive environment.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings

Tobacco cessation programs

Weight management programs

Confidential counseling

Financial coaching

Paid time off

Tuition assistance

Qualifications

• 1 year of experience processing health insurance grievance and appeal cases.
• 2+ years of experience with Medicare and/or Medicaid appeal preferred.

Responsibilities

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

Skills

Grievance processing

Appeal processing

Education

High School Diploma or GED

Job description

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, visithttps://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.