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. **Job description summary:** Prepares information and reports needed to address matters regarding complaints, appeals, and grievances. Carries out policies, procedures, and programs to ensure compliance with federal and/or state regulations. **Job Description:** Prepares information and reports needed to address matters regarding complaints, appeals, and grievances. Carries out policies, procedures, and programs to ensure compliance with federal and/or state regulations. **What you will do** + Reviews, interprets, and processes appeals and grievances filed by patients, escalating more complex issues and concerns to management for review and follow-up. + Performs patient and insurance report analysis and identifies any trends or issues that need to be addressed. + Conducts reviews of decisions and case files to determine if there are any errors or anomalies in the application of law or evidence. + Drafts and sends appeal decision letters, conducting detailed follow-up for timely and thorough follow-up and resolution. + Reviews billing and coding for all current and new medical service lines for accuracy and consistency. + Documents patient billing questions and concerns, subsequently inputting all detailed notes and records into the company database. + Prepares educational materials, training programs, and presentations to enhance understanding of the appeals and grievances process. + Coaches junior colleagues on best practices and standard operating procedures for handling complaints and appeals. + Assists with the training of junior-level staff to promote the development of departmental capabilities. **For this role you will need Minimum Requirements** + Less than 1 year work experience + Working knowledge of problem solving and decision making skills **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $17.00 - $31.30 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 02/16/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.