Senior Health Appeals Specialist

CVS Health; Hartford (CT); On-site; USD 25,000 - 53,000; Full time

Job summary

CVS Health is seeking an Appeals Processor to support the Commercial Member Clinical Appeals (CMCA) workflow in Hartford, CT. This full-time role handles daily processing of appeals determinations, intake of expedited requests, and system updates.

You will collaborate with Medical Directors, nurses, and providers, maintain timely turnaround and regulatory compliance, and contribute to reporting and panel hearing preparation.

Qualifications

• Familiar with Medical Terminology.
• Strong written and verbal communication.
• Ability to multi-task.
• Proficient in basic computer skills including Microsoft Office Suite.

Responsibilities

• Process appeals determinations and intake expedited requests.
• Update systems and generate reports as necessary.
• Support panel hearing process and triage faxes.
• Coordinate with clinical support staff (Medical Directors, Nurses, Providers).

Skills

Medical terminology

Written communication

Verbal communication

Multi-tasking

MS Office

Education

High School Diploma

Tools

Microsoft Office Suite

Job description

CVS Health is seeking an Appeals Processor to support the Commercial Member Clinical Appeals (CMCA) workflow in Hartford, CT. This full-time role handles daily processing of appeals determinations, intake of expedited requests, and system updates.

You will collaborate with Medical Directors, nurses, and providers, maintain timely turnaround and regulatory compliance, and contribute to reporting and panel hearing preparation.