Appeal and Grievance Coordinator

CVS Health

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

Posted 11/5/2026full-timeRemote • United StatesJunior💰 $17 - $31 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in managing appeals, complaints, and grievances while ensuring compliance with regulatory requirements. Proficient in analyzing benefit language and coordinating complex issues with attention to detail and effective communication.

Highest-signal resume keywords

Appeals ManagementRegulatory AnalysisAnalytical SkillsCommunication SkillsClaim Processing

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

Claim PlatformsBenefit Language ResearchPatient ManagementProduct DraftingCompliance AnalysisProvider RelationsAudit ExperienceClinical TerminologyGrievance PoliciesDecision Making

Soft Skills

Attention to DetailAbility to Work in Fast-Paced EnvironmentVerbal CommunicationWritten Communication

Tools & Technologies

ExcelMicrosoft Word

Certifications & Qualifications

High School DiplomaGED Equivalent

Industry Keywords

AppealsComplaintsGrievancesRegulatory RequirementsAccreditation Requirements

About the role

Key responsibilities & impact

Intake, investigate, and resolve appeals, complaints, and grievances across all products
Research incoming electronic appeals, complaints, and grievances and route inappropriate work items
Research plan design and coverage certification to assess benefit or administrative denials
Research claim-processing logic, member eligibility, and billing/payment status before initiating appeals
Identify and research all components of member or provider appeals, complaints, and grievances
Triage incomplete components to appropriate subject-matter experts in other business units
Coordinate all appeal, complaint, and grievance components, including final communications and closure
Serve as a technical resource to colleagues on complex issues
Identify and report trends and emerging issues and provide input on potential solutions

Requirements

What you’ll need

Must live in KY, OK, OH
1–2 years of 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 reading or researching benefit language
Ability to meet demands of a fast-paced environment with tight turnaround times
Ability to make appropriate decisions based on current policies/guidelines
Thorough knowledge of member and/or provider appeals, complaints, and grievance policies
Strong analytical skills with 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
High school diploma or GED equivalent
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