[Hiring] Intake Coordinator @CVS Health

Role Description

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.

• Review, research, and enter grievance and appeal cases within one business day of receipt.
• Monitor multiple intake sources, including call tracking, fax, email, and mail, and appropriately prioritize incoming requests.
• Intake various case types, which may include:
  • Member appeals (pre-service)
  • Member grievances
  • Provider grievances
  • Provider/claim appeals (post-service)
• Review incoming information to determine the appropriate case type and applicable processing requirements.
• Manage cases with varying turnaround times and requirements based on state, plan, and case type.
• Maintain strong organization and prioritization to ensure urgent and expedited requests are handled timely.
• Partner closely with the Quality Assurance (QA) team to ensure cases are entered accurately and required information is complete.
• Respond to questions and feedback from QA and proactively seek clarification when needed.
• Participate in weekly team meetings with Intake Coordinators, analysts, Quality team members, managers, and project managers.
• Adapt quickly to changing procedures, requirements, priorities, and workflows while maintaining accuracy and productivity.

Qualifications

• 2+ years of related experience
• Working knowledge or problem solving and decision making skills
• Critical thinking skills
• Data entry
• Grievance and appeals experience

Requirements

• 1 year of grievance and appeals experience (preferred)
• Medicare and Medicaid experience (preferred)
• Intake experience (preferred)
• Health insurance experience (preferred)

Benefits

• Comprehensive and competitive mix of pay and benefits
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility