Grievances & Appeals Intake Specialist

CVS Health; Montpelier (VT); Presencial; USD 23.000 - 39.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Descripción de la vacante

CVS Health is seeking a grievance and appeals intake specialist to review, research, and enter cases within one business day of receipt. You will monitor multiple intake sources and prioritize requests to meet deadlines.

Responsibilities include classifying cases (member appeals, member grievances, provider grievances, provider/claim appeals), coordinating with QA, and participating in weekly team meetings to improve processes and accuracy.

Formación

• Minimum 2 years of related experience.
• Working knowledge of problem solving and decision making.
• Strong data entry proficiency.
• 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, mail) and prioritize requests.
• Intake various case types (member/grievances, provider grievances, appeals).
• Review information to determine case type and processing requirements.
• Maintain organization to handle urgent/expedited requests on time.
• Collaborate with QA to ensure accurate data entry and complete information.
• Answer questions and seek clarification from QA as needed.
• Participate in weekly team meetings with intake coordinators and managers.
• Adapt to changing procedures and priorities while maintaining accuracy.

Conocimientos

Data entry

Critical thinking

Problem solving and decision making

Grievance and appeals experience

Educación

High School Diploma or equivalent

Descripción del empleo

CVS Health is seeking a grievance and appeals intake specialist to review, research, and enter cases within one business day of receipt. You will monitor multiple intake sources and prioritize requests to meet deadlines.

Responsibilities include classifying cases (member appeals, member grievances, provider grievances, provider/claim appeals), coordinating with QA, and participating in weekly team meetings to improve processes and accuracy.