Analyst Complaint Appeals

Job DescriptionThe Medicare appeals participating provider team is seeking a highly motivated intake analyst to join our team. Responsible for oversight of the intake process. Investigates and provides resolution of appeals scenarios for all products. Some may contain multiple issues and require coordination of responses from multiple business units. Ensure timely, customer focused response to appeals. Identify trends, emerging issues, report to leadership and recommend solutions. Independently coach others on appeals ensuring compliance with Federal and/or State regulations. Manage, control, and trend inventory, independently investigate, adapts to changes or revise policy to resolve the most escalated cases coming from internal and external constituents for all products. Responsible for serving as the point of contact for the appeal if there is an inquiry from leadership, compliance, and State regulators. Understand and adapt to departmental process and policies. Medicare knowledge is a plus. Fast Turn Around of inventory, collaboration with clinical team and management. Attention to detail is needed and must be able to maintain compliance turn-around times, with accurate case resolution or research. Remain a part of the solution by escalating issues that may impact compliance timeliness. Other duties as assigned.Pay RangeThe typical pay range for this role is:Minimum: 19.50Maximum: 40.10Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications3+ years experience in Medicare appeals3+ years of MHK and ECHS system experience 3+ years working with on and off shore vendorsPreferred QualificationsMedicare experienceAppeals- member, provider and non contracted providerEducationHigh School Diploma or GEDBusiness OverviewBring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-11-15