Intake Specialist - Grievances & Appeals (Health)

CVS Health; Santa Fe (NM); On-site; USD 23,000 - 39,000; Full time

Benefits offered by this job

Medical, dental & vision coverage

Paid time off

Comprehensive benefits package

Job summary

CVS Health is seeking an Intake Analyst to review, research, and enter grievance and appeal cases. You will monitor various intake channels such as call tracking, fax, email, and mail, and prioritize requests to ensure timely processing.

The role involves handling diverse case types and collaborating with QA and teams across the organization. The ideal candidate has at least 2 years of related experience, strong data entry and critical thinking skills, and knowledge of grievance and appeals

Qualifications

• 2+ years of related experience
• Strong data entry skills
• 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 prioritize incoming requests.
• Intake various case types, including: Member appeals (pre-service), Member grievances, Provider grievances, Provider/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 with QA to ensure cases entered accurately and information is complete.
• Respond to questions and feedback from QA and seek clarification when needed.
• Participate in weekly team meetings with Intake Coordinators, analysts, Quality team members, managers, and project managers.
• Adapt to changing procedures, requirements, priorities, and workflows while maintaining accuracy and productivity.

Skills

Data entry

Problem solving

Critical thinking

Education

High School Diploma or equivalent

Job description

CVS Health is seeking an Intake Analyst to review, research, and enter grievance and appeal cases. You will monitor various intake channels such as call tracking, fax, email, and mail, and prioritize requests to ensure timely processing.

The role involves handling diverse case types and collaborating with QA and teams across the organization. The ideal candidate has at least 2 years of related experience, strong data entry and critical thinking skills, and knowledge of grievance and appeals