CVS Health · 2 months ago
Grievance and Appeals- Quality Analyst - Fully Remote
United States
Full-time
Remote
Entry Level
$21.10/hr - $36.78/hr
1+ years expCVS Health is dedicated to building a more connected and compassionate health experience. The Grievance and Appeals Quality Analyst will ensure compliance with federal and state regulations regarding complaints and appeals, while also contributing to quality improvement initiatives and facilitating audits.
Health CareMedicalPharmaceuticalRetailSales
Responsibilities
Prepares and participates in external and internal audits
Analyzes basic quality and completeness of the complaints and appeals documentation to ensure the accuracy, clarity, and compliance of the information provided, including supporting documentation, timelines, and required forms or processes
Contributes to process improvements by recommending complaint and appeal process changes, as well as new training programs to drive quality results
Assists in analyzing patterns, trends, and systemic issues, working with other teams to address all complaints, and escalating more complex issues and concerns to upper management for resolution
Compiles reports on quality metrics in order to contribute to the overall improvement of service delivery and customer satisfaction
Facilitates simple inquiries, providing updates, and maintaining a customer-centric approach to enhance satisfaction and promote positive experiences
Carries out simple tasks for compliance audits by gathering documentation, providing evidence of compliance, and assisting auditors during the review process
Receives and implements regular, timely feedback to ensure delivery of exceptional services and engagement, motivation, and team development
Acts as a liaison between the organization and relevant individuals, providing updates, explanations, and clarifications throughout the process under close supervision
Qualification
Required
1+ years of Compliance experience
1+ years of External Audit Experience
1+ years of Grievance and Appeals Experience
1+ Medicare and/or Medicaid experience
High School Diploma or GED
Benefits
Affordable medical plan options
401(k) plan (including matching company contributions)
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
Company
CVS Health
CVS Health is a health solutions company that provides an integrated healthcare services to its members.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$4BKey Investors
Michigan Economic Development CorporationStarboard Value
2025-08-15Post Ipo Debt· $4B
2025-07-17Grant· $1.5M
2019-11-25Post Ipo Equity
Leadership Team
David Joyner
President and Chief Executive Officer, CVS Health
Chandra McMahon
SVP & CISO
Recent News
2026-01-25
Company data provided by crunchbase