At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

• Processes appeals and ensures timely and accurate completion.
• Maintains a caseload and monitors day to day compliance of appeal decision timeframes.
• Requests and reviews clinical and medical records for completeness.
• Assigns reviews to Medical Directors and enters all data related to appeals and case reviews into a database.
• Participates in data and analysis of reports regarding appeal activity as well as preparing for appeals audits.
• Consults with manager on complex cases and interfaces with case managers, clinical supervisors, and other personnel in resolving appeals.
• Responds to member, provider, and client telephone inquiries regarding status, process, and outcome of appeals.
• Organizes volume of work and workflow so performance standards and proper procedures for appeal resolution according to client requirements and state and federal regulations are addressed.

Required Qualifications

• 1-2 years of experience in Medicare, AHCCCS, and the healthcare industry
• Strong reading and writing skills ensuring documents meet standards and are accurate
• Excellent organizational skills

Preferred Qualifications

• Experience in customer interactions and review of health-related materials
• Strong interpersonal skills
• Attention to detail
• Self-motivated and able to work independently

Education

• HS diploma required

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.