Senior Appeals Examiner

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

The Senior Appeal Examiner (Meritain Health) is responsible for managing to resolution complaint/appeal scenarios for all products, which may contain multiple issues and, may require coordination of responses from multiple business units. This person will ensure timely, customer focused response to complaints/appeals. Identify trends and emerging issues and report and recommend solutions.

In this role, you will:

• Both review and analyze complex appeals.

• Facilitate the interpretation policy and coverage guidelines.

• Coordinate reviews as needed.

• Draft any & all resolution letters.

• Ensure the overall timely handling of assigned cases.

• Assist with the coaching & mentoring of other analysts.

• Assist with external reviews as needed.

Required Qualifications

• 1+ years of experience with healthcare, specifically in appeals, claims, and/or compliance, as well as benefit interpretation.

• 1+ years of experience with plan documents, claims research, and/or letter writing, including the documentation and interpretation of health insurance plans.

• Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook).

Preferred Qualifications

• 3+ years of experience with claims and/or health insurance. 

• Strong familiarity with medical terminology, self-funding, and/or ERISA (Employee Retirement Income Security Act) requirements.

Education

• High School Diploma or equivalent GED

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.