Intake & Appeals Specialist — Health Care

CVS Health; Saint Paul (MN); On-site; USD 23,000 - 39,000; Full time

Benefits offered by this job

Health benefits

Dental & Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is seeking an Intake Coordinator to review, research, and enter grievance and appeal cases promptly. You will monitor multiple intake sources (call tracking, fax, email, mail) and prioritize requests across member, provider, and claim appeals.

Responsibilities include determining applicable processing requirements, managing diverse case turnaround times by state and plan, and collaborating with QA to ensure accuracy. Strong organizational skills and attention to detail are essential.

Qualifications

• 2+ years of related experience
• Working knowledge of problem solving and decision making skills
• 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, 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

Grievance & appeals

Data entry

Critical thinking

Problem solving

Education

High School Diploma or equivalent

Job description

CVS Health is seeking an Intake Coordinator to review, research, and enter grievance and appeal cases promptly. You will monitor multiple intake sources (call tracking, fax, email, mail) and prioritize requests across member, provider, and claim appeals.

Responsibilities include determining applicable processing requirements, managing diverse case turnaround times by state and plan, and collaborating with QA to ensure accuracy. Strong organizational skills and attention to detail are essential.