Appeal and Grievance Coordinator

CVS Health

. Handle intake, investigation, and resolution of appeals, complaints, and grievances across all products .

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

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in handling appeals, complaints, and grievances with a strong focus on accuracy and compliance. Proficient in analyzing benefit language and coordinating case components while maintaining collaborative relationships.

Highest-signal resume keywords

Claims ProcessingRegulatory AnalysisAnalytical SkillsCommunication SkillsCustomer Service

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims PlatformsBenefit Language ResearchCompliance AnalysisPatient ManagementProduct DraftingSpecial InvestigationsProvider RelationsAudit ExperienceAttention to DetailClinical Terminology

Soft Skills

CollaborationDecision MakingAdaptabilityVerbal CommunicationWritten Communication

Tools & Technologies

Microsoft ExcelMicrosoft Word

Industry Keywords

AppealsComplaintsGrievancesMember EligibilityBilling StatusAccreditation Requirements

About the role

Key responsibilities & impact

Handle intake, investigation, and resolution of appeals, complaints, and grievances across all products
Research incoming electronic appeals, complaints, and grievances and route inappropriate work items
Research plan design or 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 cases
Triage incomplete case components to subject matter experts in other business units
Coordinate case components, final communications, resolution, and closure
Serve as a technical resource to colleagues on appeals, complaints, and grievance issues
Identify trends and emerging issues, report findings, and recommend potential solutions

Requirements

What you’ll need

MUST live in OK
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
Experience in reading or researching benefit language
High School or GED equivalent
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

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
Full-time comprehensive benefits package