Appeal and Grievance Coordinator

CVS Health

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

Posted 10/19/2026full-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 coordinating with multiple business units. Proficient in analyzing claims processing, member eligibility, and compliance with regulatory requirements.

Highest-signal resume keywords

Claims Platforms ExperienceRegulatory AnalysisAnalytical SkillsCommunication SkillsClinical Terminology Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingBenefit Language ResearchProduct DraftingCompliance AnalysisPatient ManagementAudit ExperienceGrievance Policies KnowledgeProvider Relations

Soft Skills

Attention to DetailDecision-MakingAbility to Work in High-Paced Environment

Tools & Technologies

Microsoft ExcelMicrosoft Word

Industry Keywords

AppealsComplaintsGrievancesMember EligibilityAccreditation Requirements

About the role

Key responsibilities & impact

Intake, investigate, and resolve appeals, complaints, and grievances across all products
Coordinate responses from multiple business units for cases containing multiple issues
Research incoming electronic appeals, complaints, and grievances and route inappropriate work items
Review plan design and certification of coverage to assess benefit or administrative denials
Research claim processing logic, member eligibility data, and billing/payment status
Identify and research all components of member and provider/practitioner cases
Triage incomplete case components to appropriate subject matter experts
Coordinate final communications, resolution, and closure with members/providers
Serve as a technical resource to colleagues on complex appeals, complaints, and grievance issues
Identify trends and emerging issues, report findings, and recommend potential solutions

Requirements

What you’ll need

Must live in Oklahoma
High School or GED equivalent
1–2 years of 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 reading or researching benefit language
Ability to meet demands of a high-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
Some college preferred
Experience researching and analyzing claim processing 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