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Grievance and Appeals-Quality Analyst
| Company | CVS Health |
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| Location | Ohio, USA |
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| Salary | $21.1 – $36.78 |
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| Type | Full-Time |
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| Degrees | |
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| Experience Level | Junior |
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Requirements
- 1+ years of Compliance experience
- 1+ years of External Audit Experience
- 1+ years of Grievance and Appeals Experience
- High School Diploma or GED
Responsibilities
- Prepares and participates in external and internal audits.
- Analyzes basic quality and completeness of the complaints and appeals documentation to ensure the accuracy, clarity, and compliance of the information provided, including supporting documentation, timelines, and required forms or processes.
- Contributes to process improvements by recommending complaint and appeal process changes, as well as new training programs to drive quality results.
- Assists in analyzing patterns, trends, and systemic issues, working with other teams to address all complaints, and escalating more complex issues and concerns to upper management for resolution.
- Compiles reports on quality metrics in order to contribute to the overall improvement of service delivery and customer satisfaction.
- Facilitates simple inquiries, providing updates, and maintaining a customer-centric approach to enhance satisfaction and promote positive experiences.
- Carries out simple tasks for compliance audits by gathering documentation, providing evidence of compliance, and assisting auditors during the review process.
- Receives and implements regular, timely feedback to ensure delivery of exceptional services and engagement, motivation, and team development.
- Acts as a liaison between the organization and relevant individuals, providing updates, explanations, and clarifications throughout the process under close supervision.
Preferred Qualifications
No preferred qualifications provided.
