Complaint & Appeals Analyst (Must reside in Arizona)

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary

• Processes appeals and ensures timely and accurate completion.
• Maintains a caseload and monitors day to day compliance of appeal decision timeframes.
• Requests and reviews clinical and medical records for completeness.
• Assigns reviews to Medical Directors and enters all data related to appeals and case reviews into a database.
• Participates in data and analysis of reports regarding appeal activity as well as preparing for appeals audits.
• Consults with manager on complex cases and interfaces with case managers, clinical supervisors, and other personnel in resolving appeals.
• Responds to member, provider, and client telephone inquiries regarding status, process, and outcome of appeals.
• Organizes volume of work and workflow so performance standards and proper procedures for appeal resolution according to client requirements and state and federal regulations are addressed.

• 1-2 years of experience in Medicare, AHCCCS, and the healthcare industry
• Strong reading and writing skills ensuring documents meet standards and are accurate
• Excellent organizational skills

• Experience in customer interactions and review of health-related materials
• Strong interpersonal skills
• Attention to detail
• Self-motivated and able to work independently

• HS diploma required

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an 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.