Senior Appeals Examiner - Fully Remote

$38,480 - $88,088/Yr

CVS Health - Tallahassee, FL

Full-time - Entry Level

Remote - Tallahassee, FL

Health and Personal Care Retailers

About the position

The Senior Appeals Examiner at CVS Health is responsible for managing and resolving complaint and appeal scenarios across various products. This role requires a customer-focused approach to ensure timely responses to complaints and appeals, while also identifying trends and recommending solutions based on emerging issues. The position emphasizes collaboration with multiple business units to deliver effective resolutions.

Responsibilities

• Manage complaint and appeal scenarios for all products, ensuring timely and customer-focused responses.
• Coordinate responses from multiple business units to resolve complex issues.
• Identify trends and emerging issues in complaints and appeals, reporting findings and recommending solutions.

Requirements

• 1+ years of knowledge of plan documents and claims research.
• Proficient in Excel and Word, with the ability to interpret benefits.
• Healthcare experience is required.
• 1+ years of experience working with appeals, claims, or compliance.
• 1+ years of experience documenting and interpreting Health Insurance plans.

Nice-to-haves

• 3+ years of prior claim or health insurance experience.
• Familiarity with medical terminology, self-funding, or ERISA requirements.

Benefits

• Full range of 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 and education assistance.
• Free development courses.
• CVS store discount and discount programs with participating partners.
• Paid Time Off (PTO) and paid holidays.