High-Impact Appeals & Grievance Coordinator

CVS Health; Columbus (OH); Sur place; USD 23 000 - 35 000; Plein temps

Avantages offerts par ce poste

Comprehensive medical, dental, vision

Paid time off

Retirement savings options

Wellness programs

Résumé du poste

CVS Health in Columbus, OH is seeking a detail-oriented Appeals Specialist to oversee intake, investigation and resolution of appeals, complaints and grievances across products. You will coordinate responses from multiple units, ensure timely, customer-focused communication and identify trends.

The role requires strong analytical skills, familiarity with benefit language and regulatory requirements, and the ability to work in a fast-paced environment with tight turnaround times.

Qualifications

• Experience reading or researching benefit language.
• 1–2 years in claim platforms, products and benefits, patient management, or related areas.

Responsabilités

• Research incoming electronic appeals, complaints and grievance to identify if appropriate for unit based on published responsibilities.
• Research Standard Plan Design or Certification of Coverage for accuracy and appropriateness.
• Research claim processing logic to verify payment and member eligibility before initiation of appeal.
• Identify and research all components within member or provider appeals, complaints and grievance.
• Triage incomplete components to subject matter expert for resolution content.
• Coordinate all components of appeals and final communication for resolution and closure.
• Serve as a technical resource to colleagues regarding appeals and grievance issues.
• Identify trends and report on and provide input for potential solutions.

Connaissances

Analytical skills

Communication skills

Excel

Microsoft Word

Attention to detail

Regulatory knowledge

Clinical terminology

Formation

Some college

High School diploma / GED

Description du poste

CVS Health in Columbus, OH is seeking a detail-oriented Appeals Specialist to oversee intake, investigation and resolution of appeals, complaints and grievances across products. You will coordinate responses from multiple units, ensure timely, customer-focused communication and identify trends.

The role requires strong analytical skills, familiarity with benefit language and regulatory requirements, and the ability to work in a fast-paced environment with tight turnaround times.