Senior Analyst, Complaints & Appeals
CVS Health
Posted: 10/21/2026
Appeals Analyst, CPC Certified
Blue Cross NC
Posted: 10/21/2026
Coding and Cost Analyst I
Geisinger
Posted: 10/21/2026
Compensation Analyst
1-800 CONTACTS
Posted: 10/21/2026
Senior Analyst, Capabilities
The Clorox Company
Posted: 10/21/2026AWSAzureBigQueryETLPythonSQLTableau
Analyst III, Data
TTC
Posted: 10/21/2026SQL
Senior Physicist, All-Source Analyst
Booz Allen Hamilton
Posted: 10/21/2026TypeScript
Senior Manager, Analyst Relations
Automation Anywhere
Posted: 10/21/2026RPA
Senior Thermal Analyst
BLUE ORIGIN
Posted: 10/21/2026Data Quality Audit Analyst
CVS Health
Posted: 10/21/2026
Senior Analyst, Optimize Transformation
Johnson & Johnson
Posted: 10/21/2026
Value Analysis Analyst
Vizient, Inc
Posted: 10/21/2026ERP
Ambulatory Coding Analyst – Hybrid
Franciscan Health
Posted: 10/21/2026
Product Filing Analyst
Great American Insurance Group
Posted: 10/21/2026
Senior Analyst – Long Range Capacity Planning
Intel Corporation
Posted: 10/21/2026
Senior Analyst, Contracts
RTX
Posted: 10/21/2026
Real Estate Analyst
Flexential
Posted: 10/21/2026
Systems Acquisition Analyst
AMERICAN SYSTEMS
Posted: 10/21/2026TypeScript
Medicare Appeals Analyst
Capital Blue Cross
Posted: 10/21/2026
Senior ICS Threat Hunt Analyst – Active Top Secret
Peraton
Posted: 10/21/2026CloudFirewallsSwitchingTCP/IP
Senior Analyst, Complaints & Appeals
CVS HealthCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in quality reviews, compliance with CMS regulations, and operational governance within healthcare operations. Proficient in data analysis, reporting, and process improvement to drive operational effectiveness and support leadership decision-making.
Highest-signal resume keywords
Healthcare Operations ExperienceRoot Cause AnalysisRegulatory Compliance KnowledgeData Analysis MethodologiesReport Development
About the role
Key responsibilities & impact- Perform quality reviews and audits of grievance and appeal resolutions for compliance with CMS, state, and federal regulations
- Conduct root cause analysis and analyze operational data to identify trends and complaint, grievance, and appeal drivers
- Lead governance activities, including issue identification, validation, corrective action planning, remediation tracking, and findings development
- Develop and maintain process documentation, job aids, governance materials, and operational guidance
- Serve as a subject matter expert on quality standards, regulatory requirements, operational processes, and performance measurement
- Prepare reports, dashboards, presentations, and leadership summaries communicating audit findings, operational risks, trends, and improvement opportunities
- Evaluate audit findings and provide guidance on corrective actions
- Monitor remediation efforts and evaluate corrective-action effectiveness
- Identify process gaps, operational defects, and compliance risks and recommend improvements
- Partner with Operations, Compliance, Clinical, Product, and Technology teams
- Develop actionable insights supporting leadership decisions, governance reviews, and continuous improvement
- Support projects involving process optimization, reporting enhancements, regulatory compliance, operational effectiveness, and reduction of recurring complaint and appeal drivers
Requirements
What you’ll need- 3–5 years of experience in healthcare operations, complaints and appeals, analytics, quality, compliance, governance, risk management, or related functions
- Strong analytical, problem-solving, and decision-making skills
- Experience conducting trend analysis, root cause analysis, operational reviews, and process improvement initiatives
- Experience developing reports, dashboards, and executive-level presentations
- Strong written and verbal communication skills
- Ability to collaborate across multiple business functions and influence stakeholders
- Advanced proficiency with Microsoft Excel, Microsoft PowerPoint, reporting tools, and data analysis methodologies
- Medicare Advantage, Part D, Grievance, CTM, Commercial Appeals, Provider Appeals, Utilization Management, grievance, or appeals experience preferred
- Knowledge of CMS regulations and Medicare complaint and appeal requirements preferred
- Knowledge of pre-service and prior authorization procedures and workflows preferred
- Knowledge of quality management, operational governance, and remediation tracking practices preferred
- Experience supporting governance, remediation tracking, and operational improvement initiatives preferred
- Knowledge of healthcare regulations, quality programs, and complaint and appeal workflows preferred
- Experience with automation initiatives, reporting optimization, or business intelligence solutions preferred
- Experience supporting executive-level reporting and operational performance reviews preferred
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Quality ReviewsTrend AnalysisProcess ImprovementOperational ReviewsGovernance ActivitiesRemediation TrackingOperational EffectivenessComplaint ManagementAppeal ManagementPerformance Measurement
Soft Skills
Analytical SkillsProblem-Solving SkillsDecision-Making SkillsWritten Communication SkillsVerbal Communication Skills
Tools & Technologies
Microsoft ExcelMicrosoft PowerPointReporting ToolsBusiness Intelligence SolutionsData Analysis Tools
Industry Keywords
CMS RegulationsMedicare AdvantageGrievance ManagementAppeals ProcessUtilization ManagementQuality ManagementOperational GovernanceHealthcare RegulationsPre-Service ProceduresPrior Authorization Workflows