Strategic Appeals & Grievances Coordinator

CVS Health; Lorida (FL); On-site; USD 23,000 - 43,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in Florida is seeking an Appeals Specialist to manage intake, investigation and resolution of appeals, complaints and grievances across products, coordinating with multiple business units to ensure timely, customer-focused responses.

The role requires reviewing benefit language, claim processing logic, and eligibility data to verify accuracy, coordinating final communications, and identifying trends to propose solutions.

Qualifications

• Experience reading or researching benefit language.
• 1–2 years experience in claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience.

Responsibilities

• Research appeals, complaints and grievances to determine routing and resource needs.
• Research benefit language and certification of coverage to assess accuracy of benefits/denials.
• Review claim processing logic and member eligibility data prior to initiating appeal processes.
• Coordinate across business units to gather content for final resolution communications.
• Serve as a technical resource to colleagues on appeals and grievance issues.
• Identify trends and emerging issues and report potential solutions.

Skills

Analytical skills

Attention to detail

Verbal & written communication

Education

Some college preferred

High School or GED

Job description

CVS Health in Florida is seeking an Appeals Specialist to manage intake, investigation and resolution of appeals, complaints and grievances across products, coordinating with multiple business units to ensure timely, customer-focused responses.

The role requires reviewing benefit language, claim processing logic, and eligibility data to verify accuracy, coordinating final communications, and identifying trends to propose solutions.