Complaint & Appeals Analyst, CVS Health

Complaint & Appeals Analyst

CVS Health

Location:
United States, Work At Home

Category:
Customer Service

Contract Type:
Not provided

Salary:

21.10 - 40.90 USD / Hour

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Job Description:

Processes appeals and ensures timely and accurate completion. Maintains caseload and monitors compliance of appeal decision timeframes. Reviews clinical and medical records, assigns reviews to Medical Directors, and enters data into database. Participates in data analysis and prepares for appeals audits.

Job Responsibility:

Processes appeals and ensures timely and accurate completion
Maintains a caseload and monitors day to day compliance of appeal decision timeframes
Requests and reviews clinical and medical records for completeness
Assigns reviews to Medical Directors and enters all data related to appeals and case reviews into a database
Participates in data and analysis of reports regarding appeal activity as well as preparing for appeals audits
Consults with manager on complex cases and interfaces with case managers, clinical supervisors, and other personnel in resolving appeals
Responds to member, provider, and client telephone inquiries regarding status, process, and outcome of appeals
Organizes volume of work and workflow so performance standards and proper procedures for appeal resolution according to client requirements and state and federal regulations are addressed

Requirements:

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
HS diploma 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

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation programs
Weight management programs
Confidential counseling
Financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
August 25, 2025

Expiration:
September 03, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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