Grievances & Appeals Intake Specialist

CVS Health; Indiana; In loco; USD 23.000 - 39.000; Tempo pieno

Descrizione del lavoro

CVS Health is hiring for a full‑time Intake Coordinator role focused on grievance and appeal processing in a healthcare environment. You will review, research, and enter cases daily, prioritize diverse intake sources, and manage varying turnaround times across states and plans.

Ideal candidates have 2+ years in grievances/appeals, strong problem solving and critical thinking, and familiarity with Medicare/Medicaid and health insurance administration.

Competenze

• 2+ years of related experience in grievances or appeals.
• Working knowledge of problem solving and decision making.
• Critical thinking skills.
• Data entry and grievance and appeals experience.
• 1 year of grievance and appeals experience.
• Medicare and Medicaid experience.
• Intake experience.
• Health insurance experience.

Mansioni

• Review, research, and enter grievance and appeal cases within one business day of receipt.
• Monitor intake sources, including call tracking, fax, email, and mail, and appropriately prioritize incoming requests.
• Intake various case types, which may include: Member appeals (pre-service)Member grievancesProvider grievancesProvider/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.

Conoscenze

Data entry

Grievance and appeals

Critical thinking

Problem solving

Decision making

Experience (2+ years)

Formazione

High School Diploma or equivalent

Descrizione del lavoro

CVS Health is hiring for a full‑time Intake Coordinator role focused on grievance and appeal processing in a healthcare environment. You will review, research, and enter cases daily, prioritize diverse intake sources, and manage varying turnaround times across states and plans.

Ideal candidates have 2+ years in grievances/appeals, strong problem solving and critical thinking, and familiarity with Medicare/Medicaid and health insurance administration.