Intake & Appeals Specialist — Health Insurance

CVS Health; South Dakota Park (SD); 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

Wellness programs

Job summary

CVS Health is seeking an Intake Coordinator to review, research, and enter grievance and appeal cases within one business day of receipt. The role requires monitoring multiple intake sources and prioritizing requests to ensure timely processing.

Daily duties include handling member and provider grievances and appeals, collaborating with QA, and adapting to changing procedures while maintaining accuracy and productivity. 40 hours weekly in South Dakota.

Qualifications

• 2+ years of related experience.
• Working knowledge of problem solving and decision making skills.
• Critical thinking skills.

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 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

Critical thinking

Problem solving

Decision making

Grievance and appeals experience

Education

High School Diploma or equivalent

Job description

CVS Health is seeking an Intake Coordinator to review, research, and enter grievance and appeal cases within one business day of receipt. The role requires monitoring multiple intake sources and prioritizing requests to ensure timely processing.

Daily duties include handling member and provider grievances and appeals, collaborating with QA, and adapting to changing procedures while maintaining accuracy and productivity. 40 hours weekly in South Dakota.