Intake & Appeals Specialist - Health Plan Grievances

CVS Health; Illinois; Presencial; USD 23.000 - 39.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental and vision coverage

Paid time off

Retirement savings options

Wellness programs

Descripción de la vacante

CVS Health is seeking an Intake Coordinator to review and enter grievance and appeal cases, monitoring multiple intake sources and prioritizing requests. The role involves processing member/provider grievances and appeals across different service types with a focus on accuracy and timely delivery.

You will collaborate with QA and participate in weekly team meetings, adapting to changing procedures while maintaining productivity.

Formación

• 2+ years of related experience.
• Experience with grievances and appeals processes.
• Ability to review information and determine case type.
• Strong data entry accuracy and prioritization.
• Familiarity with Medicare/Medicaid is a plus.

Responsabilidades

• Review, research, and enter grievance and appeal cases within one business day of receipt.
• Monitor intake sources (call, fax, email, mail) and prioritize requests.
• Intake cases including member/provider grievances and appeals (pre/post-service).
• Review information to determine applicable processing requirements.
• Manage cases with varying turnaround times by state, plan and type.
• Maintain organization to ensure urgent requests are handled timely.
• Collaborate with QA to ensure data accuracy and completeness.
• Respond to QA questions and seek clarification when needed.
• Participate in weekly team meetings with Intake Coordinators and project members.
• Adapt to changing procedures while maintaining accuracy and productivity.

Conocimientos

Grievance handling

Data entry

Critical thinking

Decision making

Problem solving

Educación

High School Diploma or Equivalent

Descripción del empleo

CVS Health is seeking an Intake Coordinator to review and enter grievance and appeal cases, monitoring multiple intake sources and prioritizing requests. The role involves processing member/provider grievances and appeals across different service types with a focus on accuracy and timely delivery.

You will collaborate with QA and participate in weekly team meetings, adapting to changing procedures while maintaining productivity.