Appeal Examiner- Meritain Health
CVS Health · Sacramento, CA
- Hybrid
- Full-time
- $65,000 / year
- Sacramento, CA
Job highlights
- Manage and resolve appeal scenarios.
- Interpret policies and coverage guidelines.
- Coordinate reviews and draft resolution letters.
- Ensure timely handling of assigned cases.
- Requires customer service and administrative experience.
About the role
About CVS Health
We e building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you evolutionary be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
The Appeal Examiner is responsible for managing, to resolution, appeal scenarios. These may contain responses from multiple business units. This person is responsible for ensuring timely, customer focused responses.
In This Role, You Will
- Review and analyze any relevant appeals as assigned.
- Interpret any policy and coverage guidelines as dictated by organizational policy and supervisory discretion.
- Coordinate reviews as needed.
- Draft resolution letters in order to ensure a timely and accurate response.
- Ensure timely handling of assigned cases, contingent on departmental workload and assignments.
Required Qualifications
- 1+ years customer service experience in a metrics driven environment.
- 1+ years administrative experience.
- Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook).
Preferred Qualifications
- 1+ years of experience with plan documents, appeals, compliance and/or claim research.
- 1+ year of experience with interpreting health plans and benefits.
- Strong familiarity with medical terminology, self-funding, and/or ERISA (Employee Retirement Income Security Act) requirements.
Education
High school diploma or GED.
Key skills/competency
- Appeal Examiner
- Customer Service
- Administrative Experience
- Microsoft Office
- Policy Interpretation
- Case Management
- Health Plans
- Benefits Interpretation
- Medical Terminology
- ERISA
Skills & topics
- Appeal Examiner
- Customer Service
- Administrative
- Healthcare
- Policy Interpretation
- Case Management
- Health Plans
- Benefits
- ERISA
- CVS Health
How to get hired
- Tailor your resume: Highlight your customer service, administrative experience, and any experience with health plans or appeals, aligning with the Appeal Examiner role.
- Craft a compelling cover letter: Emphasize your understanding of CVS Health's mission and how your skills meet the specific requirements of the Appeal Examiner position.
- Prepare for interviews: Be ready to discuss your experience with metrics-driven environments, policy interpretation, and problem-solving scenarios relevant to an Appeal Examiner.
- Showcase your skills: Demonstrate your proficiency in Microsoft Office Suite and any familiarity with medical terminology or ERISA.
Technical preparation
Master Microsoft Office Suite (Word, Excel, Outlook).,Familiarize with health plan documents.,Study medical terminology and common acronyms.,Understand ERISA and compliance basics.
Behavioral questions
Describe a complex appeal you resolved.,How do you manage workload and prioritize?,How do you ensure accuracy in written responses?,How do you handle difficult customer interactions?
Frequently asked questions
- What are the key responsibilities of an Appeal Examiner at CVS Health?
- As an Appeal Examiner at CVS Health, your primary responsibility is to manage and resolve appeal scenarios. This involves reviewing and analyzing assigned appeals, interpreting policy and coverage guidelines, coordinating reviews with relevant parties, and drafting timely and accurate resolution letters. You'll ensure cases are handled efficiently, considering departmental workload.
- What qualifications are essential for the Appeal Examiner role at CVS Health?
- To be considered for the Appeal Examiner position at CVS Health, you need at least one year of customer service experience in a metrics-driven environment and one year of administrative experience. Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) is also required. A high school diploma or GED is the minimum educational requirement.
- Does CVS Health offer good benefits for an Appeal Examiner?
- Yes, CVS Health offers a comprehensive benefits package for full-time colleagues, including medical, dental, and vision coverage, paid time off, retirement savings options, and wellness programs. Specific details are provided during the application process.
- What is the pay range for an Appeal Examiner at CVS Health?
- The typical pay range for an Appeal Examiner at CVS Health is between $17.00 and $31.30 per hour. This range is based on the job grade, and the actual offer will depend on factors like experience, education, and geography. The position may also be eligible for a CVS Health bonus or incentive program.
- How can I improve my chances of getting hired as an Appeal Examiner at CVS Health?
- To improve your chances, tailor your resume to highlight relevant customer service and administrative experience. Emphasize any familiarity with health plans, benefits interpretation, medical terminology, or ERISA. Prepare to discuss how you handle complex cases and ensure timely resolutions during your interview.
- What experience is preferred for the Appeal Examiner role at CVS Health?
- Preferred qualifications for the Appeal Examiner role include over one year of experience with plan documents, appeals, compliance, or claim research. Additionally, experience interpreting health plans and benefits, along with familiarity with medical terminology, self-funding, or ERISA requirements, is highly valued.