Job Details

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.Position SummaryReview, research, and enter grievance and appeal cases within one business day of receipt.Monitor multiple intake sources, including call tracking, fax, email, and mail, and appropriately prioritize incoming requests.Intake various case types, which may include: Member appeals (pre-service)Member grievancesProvider grievancesProvider/claim appeals (post-service).Review incoming information to determine the appropriate case type and applicable processing requirements.Manage cases with varying turnaround times and requirements based on state, plan, and case type.Maintain strong organization and prioritization to ensure urgent and expedited requests are handled timely.Partner closely with the Quality Assurance (QA) team to ensure cases are entered accurately and required information is complete.Respond to questions and feedback from QA and proactively seek clarification when needed.Participate in weekly team meetings with Intake Coordinators, analysts, Quality team members, managers, and project managers.Adapt quickly to changing procedures, requirements, priorities, and workflows while maintaining accuracy and productivity.Required Qualifications2+ years of related experienceWorking knowledge or problem solving and decision making skillsCritical thinking skillsData entryGrievance and appeals experiencePreferred Qualifications1 year of grievance and appeals experienceMedicare and Medicaid experienceIntake experienceHealth insurance experienceEducationHigh School Diploma or equivalentAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is: $17.00 - $28.46This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.Our people fuel our futureOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.Additional details about available benefits are provided during the application process and on Benefits Moments .We anticipate the application window for this opening will close on: 11/13/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.#J-18808-Ljbffr