Senior Appeals Examiner

This is a fully remote position, open to applicants in Alabama, +44 more states.

📋 Description

• Oversee the resolution of complaints and appeals across all products.

• Evaluate and assess intricate appeals.

• Assist in the interpretation of policy and coverage guidelines.

• Organize reviews as necessary.

• Compose resolution letters.

• Ensure that assigned cases are managed promptly.

• Detect trends and emerging issues.

• Provide reports and suggest solutions.

• Mentor and coach fellow analysts.

• Support external reviews as required.

• Coordinate responses from various business units when needed.

⛳️ Requirements

• A minimum of 1 year of experience in healthcare, particularly in appeals, claims, and/or compliance, along with benefit interpretation.

• At least 1 year of experience with plan documents, claims research, and/or letter writing, including the documentation and interpretation of health insurance plans.

• Proficient in Microsoft Office applications (Word, Excel, PowerPoint, Outlook).

• High School Diploma or equivalent GED.

• Preferred: Over 3 years of experience in claims and/or health insurance.

• Preferred: Strong knowledge of medical terminology, self-funding, and/or ERISA regulations.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial wellness.

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.