CVS Health Complaint Appeal Analyst in Blue Bell, Pennsylvania
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. Ensure timely, customer focused response to complaints/appeals. Identify trends and emerging issues and report and recommend solutions.This position can be anywhere in the United States.
1+ years experience that includes both HMO and Traditional claim platforms, products, and benefits; Patient management; product ; compliance and regulatory analysis; special investigations; provider relationscustomer service or audit experience.
Medicare experience Claims experienceExperience in reading or researching benefit language in Summary Plan Description (SPDs) or Certificate of Coverage (COCs)Experience in research and analysis of claim processing a plus
High School / GED
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.