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Appeal and Grievance Coordinator - MUST live in KY, LA or NJ
$35,360 - $59,197/Yr
CVS Health - Richmond, VA
posted 2 months ago
Full-time - Entry Level
Richmond, VA
Health and Personal Care Retailers
About the position
The position is responsible for the intake, investigation, and resolution of appeals, complaints, and grievances across all products at CVS Health. This role requires a customer-focused approach to ensure timely responses and involves coordinating with multiple business units to address complex issues. The individual will also identify trends and emerging issues, providing recommendations for solutions to enhance service delivery.
Responsibilities
- Intake, investigate, and resolve appeals, complaints, and grievances for all products.
- Ensure timely, customer-focused responses to appeals, complaints, and grievances.
- Research incoming electronic appeals to determine appropriateness for the unit based on business responsibilities.
- Identify correct resources and reroute inappropriate work items that do not meet criteria.
- Research Standard Plan Design or Certification of Coverage to determine accuracy of benefit/administrative denial.
- Verify accuracy of claim payment, member eligibility data, and billing/payment status before initiating appeals.
- Triage incomplete components of appeals to appropriate subject matter experts for resolution.
- Coordinate all components of appeals, complaints, and grievances, including final communication to members/providers.
- Serve as a technical resource to colleagues regarding appeals and grievance issues.
- Identify trends and emerging issues, reporting on and providing input for potential solutions.
Requirements
- 1-2 years of experience in claim platforms, products, benefits, patient management, compliance and regulatory analysis, or customer service.
- Experience in reading or researching benefit language.
Nice-to-haves
- Experience in research and analysis of claim processing.
Benefits
- Medical, dental, and vision benefits.
- 401(k) retirement savings plan.
- Employee Stock Purchase Plan.
- Fully-paid term life insurance plan.
- Short-term and long-term disability benefits.
- Well-being programs.
- Education assistance and free development courses.
- CVS store discount and discount programs with partners.
- Paid Time Off (PTO) and paid holidays.
