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Complaint & Appeals Analyst

United States, Work at Home Employment contract 21.10 - 40.90 USD / Hour · Job Posted May 29, 2026
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Job Description

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.

Job Responsibility

  • Independently conduct mediation conferences to solve behavioral health concerns, investigate behavioral health human rights violations ensuring compliance with Federal and/or State regulations and the Arizona Administrative Code
  • Responsible for compliance with policies of all applicable Federal and/or State government agencies, including but not limited to Center for Medicare and Medicaid Services (CMS) as well as the Arizona Health Care Cost Containment System (AHCCCS)
  • Researches and translates organizational policy into intelligent and logically written investigation reports and decision letters
  • Manages timelines to ensure state guidelines are met and investigations are timely
  • May create and communicate grievance and appeal policies, procedures, and outcomes with all levels of the organization
  • Successfully works across functions, teams, providers, and community agencies on investigations to resolve escalated cases
  • Demonstrates strong letter writing skills
  • drafts individual letters based on current findings, regulations and legislation

Requirements

  • 1-2 years of Behavioral Health experience
  • Experience in customer interactions and review of health-related materials
  • Good knowledge of Medicare, AHCCCS, and healthcare industry
  • Must reside in Arizona
  • High school diploma or GED

Nice to have

  • Strong reading and writing skills, ensuring documents meet standards and are accurate
  • Excellent organizational skills
  • Previous experience with customer interactions and review of health-related materials
  • Strong interpersonal skills
  • Attention to detail
  • Self-motivated and able to work independently

What we offer

  • Medical, dental, and vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs
  • Bonus, commission or short-term incentive program

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