Senior Appeal Examiner, CVS Health

CVS Health

Location:
United States

Category:
Customer Service

Contract Type:
Not provided

Salary:

18.50 - 42.35 USD / Hour

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Job offer has expired

Job Description:

The Senior Appeal Examiner (Meritain Health) is responsible for managing (to resolution) complaint and appeal scenarios for all products, which may contain multiple issues, and may require coordination of responses from multiple business units. This person will ensure timely, customer-focused responses to complaints and appeals, as well as identify trends and emerging issues, in order to report and recommend solutions.

Job Responsibility:

Manage (to resolution) complaint and appeal scenarios for all products, which may contain multiple issues, and may require coordination of responses from multiple business units
Ensure timely, customer-focused responses to complaints and appeals
Identify trends and emerging issues, in order to report and recommend solutions
Review and analyze complex appeals
Facilitate the interpretation policy and coverage guidelines
Coordinate reviews as needed
Draft any & all resolution letters
Ensure the overall timely handling of assigned cases
Assist with the coaching & mentoring of other analysts
Assist with external reviews as needed

Requirements:

1+ years of experience with healthcare, specifically in appeals, claims, and/or compliance, as well as benefit interpretation
1+ years of experience with plan documents, claims research, and/or letter writing, including the documentation and interpretation of health insurance plans
Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook)

Nice to have:

3+ years of experience with claims and/or health insurance
Strong familiarity with medical terminology, self-funding, and/or ERISA (Employee Retirement Income Security Act) requirements

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues 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 04, 2025

Expiration:
June 16, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Senior Appeal Examiner