We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
The Appeal Examiner is responsible for managing resolution and complaint/appeal scenarios for all products, which maycontainmultiple issuesand,may require coordination of responses from multiple business units. Ensuretimely, customer focused response to complaints/appeals.Identify trends and emerging issues and report and recommend solutions.
In this role, you will:
Review and analyze any relevant appeals as assigned.
Interpret any policy and coverage guidelines as dictated by organizational policy and supervisory discretion.
Coordinate reviews as needed.
Draft resolution letters in order to ensure a timely and accurate response.
Ensure timely handling of assigned cases, contingent on departmental workload and assignments.
Required Qualifications
1+ years customer service experience in a metrics driven environment.
1+ years administrative experience.
Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook).
Preferred Qualifications
1+ years of experience with plan documents, appeals, compliance and/or claim research.
1+ year of experience with interpreting health plans and benefits.
Strong familiarity with medical terminology, self-funding, and/or ERISA (Employee Retirement Income Security Act) requirements.
Education
High school diploma or GED.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$17.00 - $28.46This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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