Intake & Appeals Specialist

CVS Health; Kansas City (MO); On-site; USD 23,000 - 39,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health in Kansas City, MO is hiring for a Full-time Grievance and Appeals Specialist responsible for reviewing and entering cases within one business day, managing multiple intake sources, and coordinating with QA to ensure accuracy. The role supports members and providers across state programs with a focus on timely processing and prioritization.

The ideal candidate has 2+ years of grievance/appeals experience, strong data entry and critical thinking skills, and a proven ability to adapt to

Qualifications

• 2+ years of related experience
• Working knowledge of problem solving and decision making
• Critical thinking skills
• Data entry experience
• Grievance and appeals experience

Responsibilities

• Review, research, and enter grievance and appeal cases within one business day of receipt.
• Monitor multiple intake sources (call tracking, fax, email, mail) and prioritize requests.
• Intake various case types: member/grievances and provider/claims appeals (post-service).
• Review information to determine appropriate case type and processing requirements.
• Manage cases with varying timelines and requirements based on state, plan, and case type.
• Maintain organization and prioritization to handle urgent requests timely.
• Partner with QA to ensure accuracy and complete information.
• Respond to QA questions and seek clarification when needed.
• Participate in weekly team meetings with Intake Coordinators and managers.
• Adapt to changing procedures and workflows while maintaining accuracy and productivity.

Skills

Data entry

Grievance and appeals experience

Critical thinking

Problem solving

Education

High School Diploma or equivalent

Job description

CVS Health in Kansas City, MO is hiring for a Full-time Grievance and Appeals Specialist responsible for reviewing and entering cases within one business day, managing multiple intake sources, and coordinating with QA to ensure accuracy. The role supports members and providers across state programs with a focus on timely processing and prioritization.

The ideal candidate has 2+ years of grievance/appeals experience, strong data entry and critical thinking skills, and a proven ability to adapt to