Health Benefits Appeals Specialist

CVS Health; Oklahoma; Hybrid; USD 23,000 - 35,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a dedicated Appeals, Complaints and Grievances specialist to manage intake, investigation and resolution for multi-issue scenarios across products. You will ensure timely, customer-focused responses and coordinate with multiple business units to provide accurate final resolutions.

Responsibilities include researching benefit language and claim processing logic, identifying trends, and providing input on potential solutions while maintaining compliance with regulatory

Qualifications

• Experience reading or researching benefit language and applying plan design rules.
• 1–2 years experience across claim platforms, products and benefits; patient management; contract drafting; compliance and regulatory analysis; investigations; provider relations; customer service or audit.

Responsibilities

• Research incoming appeals, complaints and grievances to determine appropriate routing and response.
• Coordinate responses from multiple business units to finalize resolutions for members/providers.
• Identify trends and emerging issues and report potential solutions to leadership.
• Maintain high accuracy and meet tight turnaround times in a fast-paced environment.
• Communicate clearly, both verbally and in writing, with internal teams and external members/providers.

Skills

Benefit language research

Customer service

Regulatory analysis

Education

Some college

GED/High School

Job description

CVS Health is seeking a dedicated Appeals, Complaints and Grievances specialist to manage intake, investigation and resolution for multi-issue scenarios across products. You will ensure timely, customer-focused responses and coordinate with multiple business units to provide accurate final resolutions.

Responsibilities include researching benefit language and claim processing logic, identifying trends, and providing input on potential solutions while maintaining compliance with regulatory