Grievances & Appeals Intake Specialist

CVS Health; Virginia; Sur place; USD 23 000 - 39 000; Plein temps

Avantages offerts par ce poste

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Résumé du poste

CVS Health in Virginia is seeking an Intake Coordinator/Grievance and Appeals Specialist to review, research, and enter grievance and appeal cases within one business day of receipt. You will monitor call tracking, fax, email, and mail sources, prioritizing requests and routing cases by state, plan, and type.

A high school diploma is required; the role is full-time with comprehensive benefits. Join a team focused on accuracy, QA collaboration, and timely processing while adapting to evolving

Qualifications

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

Responsabilités

• 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 appropriately prioritize incoming requests.
• Intake various case types, including: 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.

Connaissances

Data entry

Grievance & appeals knowledge

Formation

High School Diploma or equivalent

Description du poste

CVS Health in Virginia is seeking an Intake Coordinator/Grievance and Appeals Specialist to review, research, and enter grievance and appeal cases within one business day of receipt. You will monitor call tracking, fax, email, and mail sources, prioritizing requests and routing cases by state, plan, and type.

A high school diploma is required; the role is full-time with comprehensive benefits. Join a team focused on accuracy, QA collaboration, and timely processing while adapting to evolving