Appeal and Grievance Coordinator

CVS Health Careers

. Intake, investigate, and resolve appeals, complaints, and grievances for all products .

Posted 11/5/2026full-timeRemote • Oklahoma • United StatesJunior💰 $17 - $26 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in investigating and resolving appeals, complaints, and grievances while ensuring compliance with regulatory requirements. Proficient in analyzing claims processing and benefit language to support accurate decision-making and effective communication.

Highest-signal resume keywords

Claims Processing LogicRegulatory AnalysisAppeals And Grievances ManagementAnalytical SkillsCustomer Service Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Benefit Language ResearchClaim Platforms ExperienceProduct DraftingCompliance KnowledgeAttention To DetailClinical Terminology KnowledgeResearch And AnalysisDecision-Making Based On Policies

Soft Skills

Collaborative Working RelationshipsExcellent Verbal CommunicationExcellent Written Communication

Tools & Technologies

Microsoft ExcelMicrosoft Word

Industry Keywords

Member AppealsProvider ComplaintsGrievance PoliciesPatient ManagementRegulatory Requirements

About the role

Key responsibilities & impact

Intake, investigate, and resolve appeals, complaints, and grievances for all products
Research incoming electronic appeals, complaints, and grievances and route inappropriate work items
Research plan design and certification of coverage to assess benefit or administrative denials
Research claim processing logic, claim payment accuracy, member eligibility, and billing/payment status
Identify and research all components of member or provider/practitioner appeals, complaints, and grievances
Triage incomplete components to subject matter experts in other business units
Coordinate all components through final communication and resolution closure
Serve as a technical resource to colleagues on appeals, complaints, and grievance issues
Identify trends and emerging issues and report potential solutions

Requirements

What you’ll need

Must live in Oklahoma
High School or GED equivalent
Experience in reading or researching benefit language
1-2 years experience including claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience
Ability to meet demands of a high paced environment with tight turnaround times
Ability to make appropriate decisions based upon Aetna's current policies/guidelines
Collaborative working relationships
Thorough knowledge of member and/or provider appeals, complaints and grievance policies
Strong analytical skills focusing on accuracy and attention to detail
Knowledge of clinical terminology, regulatory and accreditation requirements
Excellent verbal and written communication skills
Computer literacy, including Excel and Microsoft Word
Some college preferred
Experience in research and analysis of claim processing a plus

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being, based on eligibility