[Hiring] Senior Appeals Examiner @CVS Health

Role Description

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.

• Review and analyze complex appeals.
• Facilitate the interpretation of 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.

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).

Requirements

• 3+ years of experience with claims and/or health insurance (preferred).
• Strong familiarity with medical terminology, self-funding, and/or ERISA (Employee Retirement Income Security Act) requirements (preferred).
• Bachelor's Degree preferred.
• High School Diploma or equivalent GED.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.