Member Appeals & Grievances Specialist

CVS Health; Charleston (WV); On-site; USD 23,000 - 43,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health in the United States is seeking an Appeals Specialist to manage intake, investigation and resolution of appeals, complaints and grievances for multiple products. You will coordinate with various business units to ensure timely, customer-focused responses and escalate trends and issues.

Strong written and verbal communication, attention to detail and regulatory awareness are essential. The role requires reading benefit language, understanding claim processing and eligibility data, and

Qualifications

• Experience reading or researching benefit language.
• 1–2 years experience with claim platforms, products and benefits; patient management; compliance and regulatory analysis; customer service or audits.
• Knowledge of clinical terminology, regulatory and accreditation requirements.
• Excellent verbal and written communication skills.

Responsibilities

• Investigate and resolve appeals, complaints and grievances.
• Coordinate responses with multiple business units to finalize resolutions.
• Triager and route components to subject matter experts as needed.
• Identify trends and report potential solutions for process improvements.

Skills

Analytical skills

Communication skills

Regulatory understanding

Clinical terminology

Education

Some college

High School diploma or GED

Tools

Excel

Microsoft Word

Job description

CVS Health in the United States is seeking an Appeals Specialist to manage intake, investigation and resolution of appeals, complaints and grievances for multiple products. You will coordinate with various business units to ensure timely, customer-focused responses and escalate trends and issues.

Strong written and verbal communication, attention to detail and regulatory awareness are essential. The role requires reading benefit language, understanding claim processing and eligibility data, and