CVS Health is hiring a Complaint & Appeals Analyst to join our team. You will be responsible for processing appeals and ensuring their timely and accurate completion, directly supporting our mission of building a world of health around every consumer in a uniquely connected, convenient, and compassionate way. This role requires you to reside in Arizona.
What You'll Do
- Process appeals and ensure timely, accurate completion.
- Maintain a caseload and monitor day-to-day compliance of appeal decision timeframes.
- Request and review clinical and medical records for completeness.
- Assign reviews to Medical Directors and enter all data related to appeals and case reviews into a database.
- Participate in data analysis of reports regarding appeal activity and prepare for appeals audits.
- Consult with your manager on complex cases and interface with case managers, clinical supervisors, and other personnel in resolving appeals.
- Respond to member, provider, and client telephone inquiries regarding the status, process, and outcome of appeals.
- Organize your volume of work and workflow to meet performance standards and adhere to proper procedures for appeal resolution according to client requirements and state and federal regulations.
What We're Looking For
- 1-2 years of experience in Medicare, AHCCCS, and the healthcare industry.
- Strong reading and writing skills ensuring documents meet standards and are accurate.
- Excellent organizational skills.
- High School diploma is required.
Nice to Have
- Experience in customer interactions and review of health-related materials.
- Strong interpersonal skills.
- Attention to detail.
- Self-motivated and able to work independently.
Benefits & Compensation
- Compensation: $21.10 - $40.90 per hour.
- Affordable medical plan options.
- 401(k) plan with matching company contributions.
- Employee stock purchase plan.
- No-cost programs including wellness screenings, tobacco cessation, weight management, confidential 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 is a local position. You must reside in Arizona.
CVS Health is an equal opportunity employer. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
