[Remote] Complaint & Appeals Analyst (Must reside in Arizona)

Note: The job is a remote job and is open to candidates in USA. CVS Health is dedicated to building a connected and compassionate health experience. The Complaint & Appeals Analyst will independently conduct mediation conferences to address behavioral health concerns and ensure compliance with relevant regulations, while also managing investigations and communicating policies across the organization.

Responsibilities

• Independently conduct mediation conferences to solve behavioral health concerns, investigate behavioral health human rights violations ensuring compliance with Federal and/or State regulations and the Arizona Administrative Code
• Researches and translates organizational policy into intelligent and logically written investigation reports and decision letters
• Manages timelines to ensure state guidelines are met and investigations are timely
• May create and communicate grievance and appeal policies, procedures, and outcomes with all levels of the organization
• Successfully works across functions, teams, providers, and community agencies on investigations to resolve escalated cases
• Demonstrates strong letter writing skills; drafts individual letters based on current findings, regulations and legislation

Skills

• 1-2 years of Behavioral Health experience
• Experience in customer interactions and review of health-related materials
• Good knowledge of Medicare, AHCCCS, and healthcare industry
• Must reside in Arizona
• Strong reading and writing skills, ensuring documents meet standards and are accurate
• Excellent organizational skills
• Previous experience with customer interactions and review of health-related materials
• Strong interpersonal skills
• Attention to detail
• Self-motivated and able to work independently

Benefits

• This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
• 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.

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