Appeal and Grievance Coordinator

CVS Health

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

Posted 11/5/2026full-timeRemote • Florida • United StatesJunior💰 $17 - $28 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

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 provide accurate resolutions and maintain collaborative relationships.

Highest-signal resume keywords

Claims Platforms ExperienceRegulatory AnalysisAnalytical SkillsCommunication SkillsResearch and Analysis

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

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

Hard Skills

Claims Processing LogicBenefit Language ResearchPatient ManagementProduct DraftingCompliance KnowledgeGrievance PoliciesClinical TerminologyAttention to DetailDecision MakingTrend Identification

Soft Skills

CollaborationVerbal CommunicationWritten CommunicationProblem SolvingAdaptability

Tools & Technologies

ExcelMicrosoft Word

Industry Keywords

AppealsComplaintsGrievancesProvider RelationsCustomer ServiceAudit ExperienceAccreditation RequirementsFlorida ResidencyHigh School DiplomaGED Equivalent

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

Must live in Florida
High School or GED equivalent
1-2 years experience including claims 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
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 is 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