Grievance Resolution Specialist

CVS Health; Oklahoma; Hybrid; USD 23,000 - 36,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is seeking an Appeals Specialist to manage the intake, investigation, and resolution of appeals, complaints, and grievances across all products. You will coordinate responses with multiple business units to ensure timely, customer-focused resolutions and identify trends for process improvements.

The role requires strong analytical skills, knowledge of benefit language, and experience in handling complex regulatory considerations.

Qualifications

• Experience in reading or researching benefit language.
• 1-2 years experience including claim platforms, products, and benefits; patient management; contract drafting; compliance and regulatory analysis; investigations; provider relations; customer service or audit experience.

Responsibilities

• Handle intake, investigation and resolution of appeals, complaints and grievances across products.
• Coordinate responses from multiple business units to finalize resolutions.
• Research plan design or coverage to verify accuracy of benefits/denial decisions.
• Review claim processing, member eligibility and billing status prior to appeal initiation.
• Identify trends and potential improvements and report findings.

Skills

Benefit language research

Regulatory analysis

Customer service

Attention to detail

Education

Some college preferred.

High School or GED equivalent.

Tools

Excel

Microsoft Word

Job description

CVS Health is seeking an Appeals Specialist to manage the intake, investigation, and resolution of appeals, complaints, and grievances across all products. You will coordinate responses with multiple business units to ensure timely, customer-focused resolutions and identify trends for process improvements.

The role requires strong analytical skills, knowledge of benefit language, and experience in handling complex regulatory considerations.