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CVS Health Complaint Appeal Anly in Phoenix, Arizona

Job Description

-Responsible for opening mail, stamping mail with date stamp. -Responsible for scanning mail and distribution. Update appropriate spreadsheets regarding incoming mail. -Check line of business for each dispute. -Responsible for sending out certified mail and printing letters to ensure they are sent to outgoing mail.-Ability to meet demands of a high paced environment with tight turnaround times.-Ability to make appropriate decisions based upon Aetna's current policies/guidelines.-Collaborative working relationships.-Thorough knowledge of member and provider appeal policies.-Strong analytical skills focusing on accuracy and attention to detail.-Knowledge of clinical terminology, regulatory and accreditation requirements.-Excellent verbal and written communication skills.-Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.

Required Qualifications

Experience in reading or researching benefit language in SPDs or COCs.1-2 years experience that includes both HMO and Traditional claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience.Experience in research and analysis of claim processing a plus.

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

Able to use printer/scanner, excel, word, QNXTAble to use Date stamperNeed to live in AZ

Education

Some college preferred.High School or GED equivalent

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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