Role OverviewThis role is responsible for the intake, investigation, and resolution of appeals, complaints, and grievances for all products. The position requires coordination of responses from multiple business units and ensuring timely, customer-focused responses. The role is part of CVS Health, a company focused on simplifying health care.
What You Will Do
Research incoming electronic appeals, complaints, and grievances to determine appropriate handling. Research standard plan design or certification of coverage to determine accuracy of benefit/administrative denials. Triage incomplete components to subject matter experts and coordinate final communication to members/providers. Identify trends and emerging issues and report on potential solutions.
Why It Might Be a Fit
This role requires strong analytical skills, attention to detail, and the ability to work in a high-paced environment. Candidates should have experience reading or researching benefit language and 1-2 years of experience in claim platforms, products, benefits, or related areas. The position offers a comprehensive benefits package including medical, dental, vision, paid time off, and retirement savings.
Requirements
- Must reside in Ohio
- Experience in reading or researching benefit language
- 1-2 years experience that includes but is not limited to claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
]]>