Complaints & Appeals Analyst

CVS Health · Work from hom, OH · $18.50 - $35.29 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