Grievance & Appeals Intake Specialist

CVS Health; Athens (GA); On-site; USD 23,000 - 39,000; Full time

Job summary

CVS Health is seeking a detail-oriented Intake Reviewer to process grievance and appeal cases efficiently. You will monitor multiple intake channels and classify cases by type, ensuring accurate processing for each item in a timely manner.

Responsibilities include collaboration with QA, participating in weekly meetings, and adapting to evolving procedures to maintain accuracy and productivity in a fast-paced health services environment.

Qualifications

• 2+ years of related experience.
• Working knowledge of problem solving and decision making.
• Critical thinking skills.
• Data entry, grievance and appeals experience.

Responsibilities

• Review, research, and enter grievance and appeal cases within one business day of receipt.
• Monitor multiple intake sources, including call tracking, fax, email, and mail, and prioritize incoming requests.
• Intake various case types, including member appeals, member grievances, provider grievances and provider/claim appeals.
• Review incoming information to determine the appropriate case type and applicable processing requirements.
• Manage cases with varying turnaround times and requirements based on state, plan, and case type.
• Maintain strong organization and prioritization to ensure urgent and expedited requests are handled timely.
• Partner closely with the QA team to ensure cases are entered accurately and information is complete.
• Respond to questions and feedback from QA and seek clarification when needed.
• Participate in weekly team meetings with Intake Coordinators, analysts, QA, managers, and project managers.
• Adapt quickly to changing procedures, requirements, priorities, and workflows while maintaining accuracy and productivity.

Skills

Data entry

Grievance experience

Appeals experience

Critical thinking

Decision making

Medicare experience

Medicaid experience

Intake processing

Health insurance knowledge

Education

High School Diploma or equivalent

Job description

CVS Health is seeking a detail-oriented Intake Reviewer to process grievance and appeal cases efficiently. You will monitor multiple intake channels and classify cases by type, ensuring accurate processing for each item in a timely manner.

Responsibilities include collaboration with QA, participating in weekly meetings, and adapting to evolving procedures to maintain accuracy and productivity in a fast-paced health services environment.