Senior Appeals Examiner
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll 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 Senior Appeal Examiner (Meritain Health) is responsible for managing to resolution complaint/appeal scenarios for all products, which may contain multiple issues and, may require coordination of responses from multiple business units.
This person will ensure timely, customer focused response to complaints/appeals. Identify trends and emerging issues and report and recommend solutions
In This Role, You Will
- Both review and analyze complex appeals.
- Facilitate the interpretation policy and coverage guidelines.
- Coordinate reviews as needed.
- Draft any & all resolution letters.
- Ensure the overall timely handling of assigned cases.
- Assist with the coaching & mentoring of other analysts.
- Assist with external reviews as needed.
- Required Qualifications 1+ years of experience with healthcare, specifically in appeals , claims, and/or compliance , as well as benefit interpretation. 1+ years of experience with plan documents, claims research, and/or letter writing, including the documentation and interpretation of health insurance plans.
- Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook).
- Preferred Qualifications 3+ years of experience with claims and/or health insurance.
- Strong familiarity with medical terminology, self-funding, and/or ERISA ( Employee Retirement Income Security Act) requirements.
- Education High School Diploma or equivalent GED Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $18.50 - $42.35 This 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 people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
- This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
- The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
- Additional details about available benefits are provided during the application process and on Benefits Moments .
- We anticipate the application window for this opening will close on: 07/27/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.