# Complaints & Appeals Analyst

**Company**: CVS Health
**Location**: Work from hom, OH
**Job type**: full-time
**Salary**: $18.50 - $35.29
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/OH---Work-from-hom/Senior-Coordinator---Complaint-and-Appeals----must-reside-in-Ohio_R1056723?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/job/complaints-and-appeals-analyst-c369752e-bc2/

## Description

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

The Complaints & Appeals Analyst is responsible for reviewing, investigating, and resolving member complaints, appeals, and grievances.

**Responsibilities**

- Reviews and investigates member complaints, appeals, and grievances in accordance with established policies and procedures.

- Analyzes case information, supporting documentation, and benefit information to determine appropriate case outcomes.

- Prepares accurate and timely written correspondence related to complaint and appeal determinations.

- Ensures cases are processed within established quality, productivity, and turnaround time standards.

- Researches and resolves complex issues by collaborating with internal business partners and applicable stakeholders.

- Maintains accurate and complete case documentation in applicable systems.

- Identifies potential trends or process concerns and escalates issues as appropriate.

- Participates in departmental projects, training, and process improvement initiatives.

- Supports compliance with federal and state regulations and internal policies governing complaint and appeal activities.

**Required Qualifications**

- 5+ years of work experience with Medicaid Complaint & Appeals

- Strong analytical, problem-solving, and decision-making skills.

- Excellent written and verbal communication skills.

- Ability to manage multiple priorities and adhere to established deadlines.

- Proficiency in Microsoft Office applications.

**Preferred Qualifications**

- Experience in healthcare, insurance, claims, customer service, complaints and appeals, or related operations.

- Experience researching and resolving complex customer or member issues.

- Knowledge of health plan benefits, claims, and appeals processes preferred.

**Education**

- High school diploma or equivalent required.

**Benefits**

- Medical, dental, and vision coverage

- Paid time off

- Retirement savings options

- Wellness programs

**Pay Range**

- $18.50 - $35.29

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## Skills

### Required
- analytical skills
- problem-solving skills
- Microsoft Office applications
- written and verbal communication skills

### Nice to have
- healthcare
- insurance
- claims
- customer service
- complaints and appeals

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/OH---Work-from-hom/Senior-Coordinator---Complaint-and-Appeals----must-reside-in-Ohio_R1056723?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)