Grievance and Appeals Quality Analyst - Remote

Overview

The Grievance and Appeals Quality Analyst at CVS Health plays a critical role in ensuring compliance with federal and state regulations related to complaints and appeals, contributing to quality improvements and customer satisfaction.

In Short

• Applies in-depth knowledge of compliance and audits.
• Analyzes quality and completeness of complaints and appeals documentation.
• Recommends process improvements for complaints and appeals.
• Compiles reports on quality metrics to enhance service delivery.
• Acts as a liaison between the organization and relevant individuals.
• Facilitates inquiries and maintains a customer-centric approach.
• Assists in compliance audits and provides necessary documentation.
• Receives feedback to ensure exceptional service delivery.
• Collaborates with teams to address complaints and trends.
• Participates in internal and external audits.

Requirements

• 1+ years of Compliance experience.
• 1+ years of External Audit Experience.
• 1+ years of Grievance and Appeals Experience.
• High School Diploma or GED.
• Strong analytical and communication skills.
• Ability to work independently and in teams.
• Customer service orientation.
• Willingness to receive and implement feedback.
• Experience in healthcare compliance preferred.
• Familiarity with federal and state regulations.

Benefits

• Comprehensive medical plan options.
• 401(k) plan with company matching.
• Employee stock purchase plan.
• No-cost wellness programs and counseling services.
• Flexible work schedules and paid time off.
• Tuition assistance and family leave options.
• Resources for dependent care.
• Retiree medical access.
• Support for mental health and financial coaching.
• Commitment to workplace diversity and inclusion.