Appeal and Grievance Coordinator - Remote

Overview

The Appeal and Grievance Coordinator at CVS Health is responsible for managing the intake, investigation, and resolution of appeals, complaints, and grievances across various products, ensuring timely and customer-focused responses.

In Short

• Manage appeals, complaints, and grievances for multiple products.
• Research and determine the appropriateness of incoming issues.
• Coordinate responses from various business units.
• Identify trends and recommend solutions.
• Serve as a technical resource for colleagues.
• Ensure compliance with policies and regulations.
• Maintain thorough documentation of all cases.
• Utilize strong analytical skills for problem-solving.
• Communicate effectively with members and providers.
• Work in a fast-paced environment with tight deadlines.

Requirements

• 1-2 years of experience in customer service or claims.
• Experience with benefit language and claims processing.
• Strong analytical and communication skills.
• Proficiency in Microsoft Excel and Word.
• Some college education preferred.
• Knowledge of clinical terminology and regulatory requirements.

Benefits

• Competitive wages and comprehensive benefits package.
• 401(k) plan with company matching contributions.
• No-cost wellness programs and counseling.
• Paid time off and flexible work schedules.
• Tuition assistance and dependent care resources.
• Employee stock purchase plan.