Senior Appeals Examiner

CVS Health

1d • $19 - $42

About The Position

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 Responsible for managing to resolution complaint/appeal scenarios for all products, which may contain multiple issues and, may require coordination of responses from multiple business units. Ensure timely, customer focused response to complaints/appeals. Identify trends and emerging issues and report and recommend solutions.

Requirements

• 1 plus years knowledge of plan documents, claims research, letter writing.
• 1 plus years working with appeals, claims, or compliance.
• 1 plus years experience working with documenting and interpreting Health Insurance plans.
• Understand excel and word.
• Able to interpret benefits.
• Healthcare experience.

Nice To Haves

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

Responsibilities

• Responsible for managing to resolution complaint/appeal scenarios for all products, which may contain multiple issues and, may require coordination of responses from multiple business units.
• Ensure timely, customer focused response to complaints/appeals.
• Identify trends and emerging issues and report and recommend solutions.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
• For more information, visit https://jobs.cvshealth.com/us/en/benefits

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree