Quality Appeal Coordinator (Meritain Health)

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
The Quality Appeal Coordinator coordinates reviews and evaluations for complaints and appeals received by the organization. This includes denied claims, coverage issues, medical necessity, service quality, or other concerns expressed by patients, providers, or other stakeholders. This person applies in-depth knowledge of subject matter and independently coaches others on matters regarding complaints and appeals.In this role, you will:

• Handle quality checks for the appeals team, in order to ensure overall accuracy.
• Regularly trend quality errors for both the team and individuals.
• Hold coaching session for the team, in order to address any commonly occurring errors.
• Answer any and all questions related to appeals, as needed and designated.
• Assist in keeping relevant workflows up to date.

Required Qualifications

• 2-4 years of experience in appeals.
• Knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook).

Preferred Qualifications

• Prior experience working with claims.
• Prior experience in health insurance.
• Prior experience in compliance or auditing.
• Basic awareness of problem solving and decision-making skills.

Education

• High school diploma or GED.

Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$21.10 - $49.08This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 08/25/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Client-provided location(s): Harrisburg, PA

Job ID: CVS-R0674897_1036

Employment Type: FULL_TIME

Posted: 2025-08-13T19:44:04