If you’re good at reading benefit language, tracking down what actually happened in a claim, and writing clean, defensible responses under tight deadlines, this is your type of role. You’ll investigate appeals, complaints, and grievances end-to-end, coordinate with multiple teams, and make sure members and providers get timely, customer-focused resolutions.
About CVS Health
CVS Health is building a more connected, convenient, and compassionate healthcare experience nationwide. This team supports members and providers by researching benefit and claim issues, resolving appeals and grievances accurately, and identifying trends that can improve operations and reduce repeat problems.
Schedule
- Fully remote, must reside in Louisiana
- Full-time: 40 hours per week
- Application window expected to close December 31, 2025
What You’ll Do
⦁ Intake, investigate, and resolve appeals, complaints, and grievance scenarios across products (often with multiple issues)
⦁ Review incoming electronic cases and route non-qualifying items to the correct team
⦁ Research Standard Plan Design/Certification of Coverage to confirm benefit or administrative denial accuracy
⦁ Review claim processing logic to verify payment accuracy, eligibility, and billing/payment status
⦁ Identify all components of member or provider appeals and grievances and determine what’s needed for resolution
⦁ Triage incomplete case components to subject matter experts in other business units and coordinate response content
⦁ Deliver final written communication to members/providers and close cases within required turnaround times
⦁ Serve as a technical resource to colleagues for higher-complexity appeals and grievance situations
⦁ Track trends and emerging issues and provide input on solutions to reduce repeat cases
What You Need
⦁ Must live in Louisiana
⦁ Experience reading or researching benefit language
⦁ 1–2 years of experience in areas such as: claim platforms/products/benefits, patient management, contract drafting, compliance/regulatory analysis, special investigations, provider relations, customer service, or audit work
⦁ Strong analytical thinking with attention to detail and accuracy
⦁ Ability to work in a fast-paced environment with tight turnaround times
⦁ Strong written and verbal communication skills
⦁ Computer literacy and ability to navigate systems (including Excel and Word)
⦁ High school diploma or GED (some college preferred)
Benefits
⦁ Pay range: $17.00 to $25.65 (varies by experience, location, and qualifications)
⦁ Affordable medical plan options and 401(k) with company match
⦁ Employee stock purchase plan eligibility
⦁ No-cost wellness programs plus confidential counseling and financial coaching
⦁ Paid time off, flexible schedules, family leave, tuition assistance, and other benefits based on eligibility
This posting is expected to close December 31, 2025. If you’re in Louisiana and you’ve got benefit-language skill plus the patience to research and write tight responses, this is a strong lane.
Real talk: this is a “paper trail and deadlines” job. If you like solving puzzles and documenting the fix clearly, you’ll do well here.
Happy Hunting,
~Two Chicks…