CVS Health is looking for an Appeal and Grievance Coordinator to join our team. In this role, you will be responsible for the intake, investigation, and resolution of complex appeals, complaints, and grievances, coordinating responses from multiple business units to ensure timely, customer-focused resolutions. You'll also play a key role in identifying trends and emerging issues. You must currently live in Oklahoma (OK) or Louisiana (LA) to be considered.
What You'll Do
- Research incoming electronic appeals, complaints, and grievances to determine appropriateness for the unit.
- Identify correct resources and reroute inappropriate work items.
- Research Standard Plan Design or Certification of Coverage to verify benefit or administrative denials.
- Investigate claim processing logic to confirm accuracy prior to initiating appeals.
- Identify and research all components within member or provider appeals for all products.
- Triage incomplete components to subject matter experts in other business units.
- Coordinate all components of appeals, including final communication to members or providers for resolution and closure.
- Serve as a technical resource to colleagues on appeals and grievance issues.
- Identify trends and emerging issues and report on potential solutions.
What We're Looking For
- 1–2 years of relevant experience in claims platforms, benefits, customer service, compliance, or a related field.
- Experience in reading or researching benefit plan language.
- Ability to thrive in a high-paced environment with tight turnaround times.
- Ability to make appropriate decisions based on current policies and guidelines.
- Proven collaborative working relationships.
- Thorough knowledge of member and provider appeals, complaints, and grievance policies.
- Strong analytical skills with a focus on accuracy and attention to detail.
- Knowledge of clinical terminology, regulatory and accreditation requirements.
- Excellent verbal and written communication skills.
- Computer literacy, including proficiency with Excel and Microsoft Word.
- A High School diploma or GED equivalent.
- Must currently live in Oklahoma (OK) or Louisiana (LA).
Nice to Have
- Experience in research and analysis of claim processing.
- Some college education is preferred.
Technical Stack
- Microsoft Excel
- Microsoft Word
Benefits & Compensation
- Compensation: $17.00 - $25.65 per hour
- Affordable medical plan options
- 401(k) plan with matching company contributions
- Employee stock purchase plan
- No-cost wellness programs, tobacco cessation, weight management, counseling, and financial coaching
- Paid time off and flexible work schedules
- Family leave and dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
Work Mode
This role is open to candidates based in Oklahoma (OK) or Louisiana (LA).
CVS Health is passionate about transforming health care and caring for people where, when, and how they choose in a more connected, convenient, and compassionate way. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all applicable laws.
