Grievance & Appeals Intake Specialist

CVS Health; Idaho Falls (ID); Presencial; USD 23.000 - 39.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Descripción de la vacante

CVS Health is seeking an Intake Coordinator to review and enter grievance and appeal cases within one business day of receipt. You will monitor multiple intake sources and prioritize requests to ensure timely processing.

The role covers member and provider grievances and appeals, with collaboration with QA and adaptable procedures to maintain accuracy. A high school diploma and 2+ years of related experience are typical; full-time hours with comprehensive benefits.

Formación

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

Responsabilidades

• Review, research, and enter grievance and appeal cases within one business day of receipt.
• Monitor intake sources (call tracking, fax, email, and mail) and prioritize requests.
• Intake various case types, which may include: Member appeals (pre-service), Member grievances, Provider grievances, Provider/claim appeals (post-service).
• 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 Quality Assurance (QA) team to ensure cases are entered accurately and required information is complete.
• Respond to questions and feedback from QA and proactively seek clarification when needed.
• Participate in weekly team meetings with Intake Coordinators, analysts, Quality team members, managers, and project managers.
• Adapt quickly to changing procedures, requirements, priorities, and workflows while maintaining accuracy and productivity.

Conocimientos

Data entry

Problem solving

Decision making

Critical thinking

Grievance and appeals experience

Educación

High School Diploma or equivalent

Descripción del empleo

CVS Health is seeking an Intake Coordinator to review and enter grievance and appeal cases within one business day of receipt. You will monitor multiple intake sources and prioritize requests to ensure timely processing.

The role covers member and provider grievances and appeals, with collaboration with QA and adaptable procedures to maintain accuracy. A high school diploma and 2+ years of related experience are typical; full-time hours with comprehensive benefits.