Appeal and Grievance Coordinator

CVS Health

. Intake, investigate and resolve appeals, complaints and grievances for 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 ensuring compliance with regulatory requirements. Proficient in analyzing claims processing and benefit language to provide accurate resolutions and recommendations.

Highest-signal resume keywords

Claims Platforms ExperienceRegulatory AnalysisAnalytical SkillsCommunication SkillsKnowledge of Clinical Terminology

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingBenefit Language ResearchProduct DraftingCompliance AnalysisPatient ManagementProvider RelationsAudit ExperienceGrievance Policies KnowledgeDecision-Making Based on PoliciesAttention to Detail

Soft Skills

Strong Analytical SkillsExcellent Verbal CommunicationExcellent Written Communication

Tools & Technologies

ExcelMicrosoft Word

Industry Keywords

AppealsComplaintsGrievancesRegulatory RequirementsAccreditation Requirements

About the role

Key responsibilities & impact

Intake, investigate and resolve appeals, complaints and grievances for all products
Research incoming electronic cases and route inappropriate work items
Review plan designs and certificates of coverage to assess benefit or administrative denials
Research claim-processing logic, member eligibility, and billing/payment status
Identify and research all components of member and provider appeals, complaints, and grievances
Triage incomplete components to subject matter experts in other business units
Coordinate case components and final communications for 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 solutions

Requirements

What you’ll need

Must live in Oklahoma
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
High school diploma or GED equivalent
Ability to meet demands of a fast-paced environment with tight turnaround times
Ability to make decisions based on Aetna's 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
Comprehensive benefits package for eligible full-time colleagues