Appeal and Grievance Coordinator

Job not on LinkedIn

🔥 13 minutes ago

🌪️ Oklahoma – Remote

🌪️ Oklahoma – Remote

💵 $17 - $25 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Intake, investigate, and resolve appeals, complaints, and grievances across all products • Research incoming electronic cases to determine appropriate unit ownership and reroute inappropriate work items • Research plan designs or coverage certifications to assess benefit or administrative denials • Research claim processing logic, member eligibility data, and billing/payment status before initiating appeals • Identify and research all components of member or provider appeals, complaints, and grievances • Triage incomplete components to subject matter experts in other business units • Coordinate all case components, final member/provider communication, resolution, and closure • Serve as a technical resource to colleagues on complex appeals, complaints, and grievance issues • Identify trends and emerging issues and report findings and potential solutions

🎯 Requirements

• Must live in Oklahoma • High School or GED equivalent • 1–2 years of experience including claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service; or audit experience • Experience reading or researching benefit language • Ability to meet demands of a high-paced environment with tight turnaround times • Ability to make appropriate decisions based on current policies/guidelines • Thorough knowledge of member and/or provider appeals, complaints, and grievance policies • Strong analytical skills with accuracy and attention to detail • Knowledge of clinical terminology, regulatory, and accreditation requirements • Excellent verbal and written communication skills • Computer literacy, including internal/external computer systems, Excel, and Microsoft Word

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility • Comprehensive benefits package for eligible full-time colleagues

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