Appeal and Grievance Coordinator

Job not on LinkedIn

🔥 4 hours 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 for all products • Research incoming electronic cases and determine whether they meet unit responsibilities and criteria • Identify correct resources and reroute inappropriate work items • Research plan design or coverage certifications to assess benefit or administrative denials • Research claim-processing logic, claim payments, member eligibility and billing/payment status • 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 communications and resolution closure • Serve as a technical resource to colleagues on appeals, complaints and grievance issues • Identify and report trends and emerging issues and provide input on potential solutions

🎯 Requirements

• Must live in Oklahoma • 1–2 years of experience including claims 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 fast-paced environment with tight turnaround times • Ability to make appropriate decisions based on current policies/guidelines • Collaborative working relationships • 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 • High school diploma or GED equivalent • Some college preferred

🏖️ Benefits

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

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