Grievance and Appeals- Quality Analyst, CVS Health

CVS Health

Location:
United States, Work At Home, Ohio

Category:
Customer Service

Contract Type:
Not provided

Salary:

21.10 - 36.78 USD / Hour

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Job offer has expired

Job Description:

Applies in-depth knowledge of subject matter and independently coaches others on matters regarding complaints and appeals, ensuring compliance with federal and/or state regulations. Ensures compliance with policies of all applicable federal and/or state government agencies, including but not limited to the Center for Medicaid and Medicare (CMS), Department of Public Welfare, Department of Health, and Department of Insurance.

Job Responsibility:

Prepares and participates in external and internal audits
Analyzes basic quality and completeness of the complaints and appeals documentation
Contributes to process improvements by recommending complaint and appeal process changes
Assists in analyzing patterns, trends, and systemic issues
Compiles reports on quality metrics
Facilitates simple inquiries
Carries out simple tasks for compliance audits
Receives and implements regular, timely feedback
Acts as a liaison between the organization and relevant individuals

Requirements:

1+ years of Compliance experience
1+ years of External Audit Experience
1+ years of Grievance and Appeals Experience
High School Diploma or GED

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost programs including wellness screenings, tobacco cessation and weight management programs, confidential counseling and 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:
June 14, 2025

Expiration:
June 15, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Grievance and Appeals- Quality Analyst

CVS Health

Location:United States, Work At Home, Ohio

Category:Customer Service

Contract Type:Not provided