Grievance Analyst - Case Review

Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

CVS Health has an exciting new opportunity within the Grievances team in Scottsdale, AZ. As a Grievances Analyst, you will be responsible for ensuring Grievance resolutions address member concerns and are in accordance with Centers of Medicare & Medicaid Services (CMS) guidelines. This role is critical to ensuring high quality results, meeting department and CMS mandated TAT and mentoring caseworkers. As part of this role, you will be required to interact directly with clients and internal business partners. You will perform an end-to-end quality review of written grievances resolution letters and summaries that are drafted by the caseworkers and provide feedback to ensure department and CMS required quality objectives are met. Additionally, you will support the needs of the department in multiple audit functions (CMS Program Audit, client requested mock audits, and 3rd party generated audits) that are a direct result of the quality process. Lastly, the Grievances Analyst will complete full root-cause analysis functions, providing process improvement recommendations across multiple internal business units, deliver interdepartmental training, with the goal of improving the member experience.2+ years of experience with the Microsoft Office Suite, Word, Outlook, etc. 1+ years of Med D work experience.2+ years of general business experience that includes problem resolution, business writing, quality improvement and/or customer service. 1+ year of PBM/pharmaceutical related work strongly desired.H.S. or Equivalent Bachelors Degree Preferred

Pay Range

The typical pay range for this role is:

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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

CVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health colleagues can initiate a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through myHR (1-888-694-7287, or through myLeave at myHR). If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.