Appeal and Grievance Coordinator

CVS Health

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

Posted 10/19/2026full-timeRemote • 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 investigating and resolving appeals, complaints, and grievances while ensuring compliance with regulatory requirements. Proficient in research and analysis of claims processing, benefit language, and member eligibility data.

Highest-signal resume keywords

Claims Processing AnalysisAppeals And Grievances ManagementRegulatory Compliance KnowledgeStrong Analytical SkillsExcellent Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Benefit Language ResearchClaims Platforms ExperiencePatient ManagementProduct DraftingCompliance AnalysisRegulatory AnalysisProvider RelationsAudit ExperienceClinical Terminology KnowledgeDecision-Making Based On Policies

Soft Skills

Attention To DetailCollaborationAbility To Work In High-Paced Environment

Tools & Technologies

ExcelMicrosoft Word

Industry Keywords

Member AppealsProvider ComplaintsGrievance PoliciesAccreditation 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 or certification of coverage to determine benefit or administrative denial accuracy
Research claim processing logic, member eligibility data, and billing/payment status
Identify and research all components of member or provider appeals, complaints, and grievances
Triage incomplete components to appropriate subject matter experts
Coordinate all components, including 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 KY, OK, and OH
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
Experience in research and analysis of claim processing is a plus
High School or GED equivalent
Knowledge of member and/or provider appeals, complaints and grievance policies
Knowledge of clinical terminology, regulatory and accreditation requirements
Strong analytical skills focusing on accuracy and attention to detail
Excellent verbal and written communication skills
Computer literacy, including Excel and Microsoft Word
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

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