At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. **Position Summary** The **Senior Appeal Examiner (Meritain Health)** is responsible for managing (to resolution) complaint and 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 responses to complaints and appeals, as well as identify trends and emerging issues, in order to 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 GED. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $18.50 - $42.35 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: 06/16/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. 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.