Complaint & Appeals Analyst - Remote

Overview

The Complaint & Appeals Analyst at CVS Health is responsible for processing appeals, maintaining compliance, and ensuring accurate completion of case reviews while interfacing with various stakeholders.

In Short

• Processes appeals and ensures timely completion.
• Maintains a caseload and monitors compliance.
• Requests and reviews clinical and medical records.
• Assigns reviews to Medical Directors.
• Participates in data analysis and prepares reports.
• Consults with management on complex cases.
• Responds to inquiries regarding appeal status.
• Organizes work to meet performance standards.
• Works independently and self-motivated.
• Ensures compliance with regulations.

Requirements

• 1-2 years of experience in Medicare and healthcare.
• Strong reading and writing skills.
• Excellent organizational skills.
• Experience in customer interactions.
• Strong interpersonal skills.
• Attention to detail.
• HS diploma required.

Benefits

• Affordable medical plan options.
• 401(k) plan with matching contributions.
• No-cost wellness programs.
• Flexible work schedules.
• Tuition assistance.
• Employee stock purchase plan.
• Confidential counseling and financial coaching.
• Paid time off and family leave.
• Retiree medical access.
• Comprehensive benefits for colleagues.