Appeal and Grievance Coordinator

$35,360 - $65,104/Yr

CVS Health - Springfield, IL

Full-time - Entry Level

Springfield, IL

Health and Personal Care Retailers

About the position

The Appeal and Grievance Coordinator at CVS Health is responsible for the intake, investigation, and resolution of appeals, complaints, and grievances across various products. This role requires a customer-focused approach to ensure timely responses and involves coordinating with multiple business units to address complex issues. The coordinator will also identify trends, conduct research, and provide technical support to colleagues, all while maintaining a high level of accuracy and attention to detail.

Responsibilities

• Intake, investigate, and resolve appeals, complaints, and grievances for all products.
• Ensure timely, customer-focused responses to appeals and complaints.
• Identify trends and emerging issues, reporting and recommending solutions.
• Research incoming electronic appeals to determine appropriateness based on business responsibilities.
• Identify correct resources and reroute inappropriate work items.
• Research Standard Plan Design or Certification of Coverage for accuracy of benefit denials.
• Verify accuracy of claim payments and member eligibility data before initiating appeals.
• Triage incomplete components of appeals to appropriate subject matter experts for resolution.
• Coordinate all components of appeals, including final communication to members/providers for resolution.
• Serve as a technical resource regarding appeals and grievance issues.

Requirements

• High school diploma or GED equivalent.
• 1-2 years of experience in claims platforms, patient management, or customer service.
• Experience in reading or researching benefit language.
• Strong analytical skills with attention to detail.
• Excellent verbal and written communication skills.
• Computer literacy, including proficiency in Microsoft Word and Excel.

Nice-to-haves

• Some college education preferred.
• Experience in research and analysis of claim processing.

Benefits

• Store discount
• Employee stock purchase plan
• Paid holidays
• Disability insurance
• Health insurance
• Dental insurance
• 401(k)
• Paid time off
• Vision insurance
• Life insurance