Intake & Appeals Specialist (Grievances)

CVS Health; Williamstown (NJ); On-site; USD 23,000 - 39,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in New Jersey is seeking a full-time Intake/Grievance Specialist to review, research, and enter grievance and appeal cases within one business day of receipt. You will monitor multiple intake sources and prioritize requests to ensure timely processing.

Responsibilities include intake of member, provider, and claim cases, collaboration with QA, and adherence to state-specific requirements. The role offers comprehensive benefits and a stable, purpose-driven environment.

Qualifications

• 2+ years of related experience.
• Working knowledge or problem solving and decision making skills
• Critical thinking skills
• Data entry
• Grievance and appeals experience
• Medicare and Medicaid experience
• Intake experience
• Health insurance experience

Responsibilities

• 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, which may include: Member appeals (pre-service)Member grievancesProvider grievancesProvider/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.

Skills

Data entry

Grievance and appeals experience

Critical thinking

Problem solving and decision making

2+ years of related experience

Education

High School Diploma or equivalent

Job description

CVS Health in New Jersey is seeking a full-time Intake/Grievance Specialist to review, research, and enter grievance and appeal cases within one business day of receipt. You will monitor multiple intake sources and prioritize requests to ensure timely processing.

Responsibilities include intake of member, provider, and claim cases, collaboration with QA, and adherence to state-specific requirements. The role offers comprehensive benefits and a stable, purpose-driven environment.