Member Appeals & Grievances Specialist

CVS Health; Kentucky; Hybrid; USD 23.000 - 43.000; Vollzeit

Benefits dieser Stelle

Medical coverage

Dental coverage

Vision coverage

Retirement savings

Paid time off

Zusammenfassung

CVS Health is seeking an Appeals Specialist to manage intake, investigation and resolution of appeals, complaints and grievances across products. You will coordinate responses from multiple units to ensure timely, customer-focused resolution and identify trends to inform improvements.

The role requires strong analytical skills, familiarity with benefit language and policy guidance, and proficiency with Excel/Word.

Qualifikationen

• Experience reading or researching benefit language.
• 1-2 years experience in claims or benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience.
• Experience in research and analysis of claim processing is a plus.

Aufgaben

• Handle intake, investigation and resolution of appeals and grievances.
• Coordinate responses from multiple business units.
• Identify trends and report solutions to improve processes.
• Serve as a technical resource on appeals issues.

Kenntnisse

Analytical skills

Verbal communication

Written communication

Attention to detail

Excel

Word processing

Ausbildung

Some college or equivalent

High School diploma or GED

Tools

Excel

Word

Jobbeschreibung

CVS Health is seeking an Appeals Specialist to manage intake, investigation and resolution of appeals, complaints and grievances across products. You will coordinate responses from multiple units to ensure timely, customer-focused resolution and identify trends to inform improvements.

The role requires strong analytical skills, familiarity with benefit language and policy guidance, and proficiency with Excel/Word.