# Appeals, Complaints and Grievances Specialist

**Company**: CVS Health
**Location**: Work from home, OK
**Job type**: full-time
**Salary**: $17.00 - $25.65
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/OK---Work-from-home/Appeal-and-Grievance-Coordinator---MUST-live-in-OK_R1083972?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/job/appeals-complaints-and-grievances-specialist-af1ba556-c36/

## Description

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

Responsible for intake, investigation and resolution of appeals, complaints and grievances scenarios for all products. You will ensure timely, customer-focused responses to appeals, complaints and grievances, identifying trends and emerging issues, and recommending solutions.

Key Responsibilities:

- Research incoming electronic appeals, complaints and grievances to identify if they're appropriate for your unit.

- Investigate and resolve appeals, complaints and grievances in a customer-focused manner.

- Coordinate responses from multiple business units and communicate effectively with members and providers.

- Analyze data to identify trends and emerging issues, and provide recommendations for improvement.

- Serve as a technical resource to colleagues regarding appeals, complaints and grievance issues.

Requirements:

- Experience in reading or researching benefit language.

- 1-2 years of experience in claim platforms, products, benefits, patient management, product or contract drafting, compliance and regulatory analysis, special investigations, provider relations, customer service or audit experience.

- Strong analytical skills, attention to detail, and excellent verbal and written communication skills.

- Computer literacy in Microsoft Office, including Excel and Word.

Preferred Qualifications:

- Experience in research and analysis of claim processing.

Education:

- Some college preferred.

- High School or GED equivalent.

Benefits:

- Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, and wellness programs.

For more fresh new jobs, check out [yubhub.co](https://yubhub.co/).

## Skills

### Required
- analytical skills
- benefit language
- claim platforms
- compliance and regulatory analysis
- customer service
- Microsoft Office

### Nice to have
- research and analysis of claim processing

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/OK---Work-from-home/Appeal-and-Grievance-Coordinator---MUST-live-in-OK_R1083972?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)