Note: The job is a remote job and is open to candidates in USA. CVS Health is dedicated to building a connected and compassionate health experience. The Complaint & Appeals Analyst will independently conduct mediation conferences to address behavioral health concerns and ensure compliance with relevant regulations, while also managing investigations and communicating policies across the organization.
Responsibilities
- Independently conduct mediation conferences to solve behavioral health concerns, investigate behavioral health human rights violations ensuring compliance with Federal and/or State regulations and the Arizona Administrative Code
- Researches and translates organizational policy into intelligent and logically written investigation reports and decision letters
- Manages timelines to ensure state guidelines are met and investigations are timely
- May create and communicate grievance and appeal policies, procedures, and outcomes with all levels of the organization
- Successfully works across functions, teams, providers, and community agencies on investigations to resolve escalated cases
- Demonstrates strong letter writing skills; drafts individual letters based on current findings, regulations and legislation
Skills
- 1-2 years of Behavioral Health experience
- Experience in customer interactions and review of health-related materials
- Good knowledge of Medicare, AHCCCS, and healthcare industry
- Must reside in Arizona
- Strong reading and writing skills, ensuring documents meet standards and are accurate
- Excellent organizational skills
- Previous experience with customer interactions and review of health-related materials
- Strong interpersonal skills
- Attention to detail
- Self-motivated and able to work independently
Benefits
- This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
- This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
- The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Company Overview
CVS Health is a health solutions company that provides an integrated healthcare services to its members. It was founded in 1963, and is headquartered in Woonsocket, Rhode Island, USA, with a workforce of 10001+ employees. Its website is https://www.cvshealth.com/.