CVS Health

Senior Appeals Examiner

FL - Work from home Full time

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
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. Ensure timely, customer focused response to complaints/appeals. Identify trends and emerging issues and report and recommend solutions.

Required Qualifications

  • 1 plus years knowledge of plan documents, claims research, letter writing.

  • 1 plus years working with appeals, claims, or compliance. (and/ or)

  • 1 plus years experience working with documenting and interpreting Health Insurance plans.

  • Understand excel and word.

  • Able to interpret benefits.

  • Healthcare experience.


Preferred Qualifications

  • 3 plus years of prior claim or health insurance experience. 

  • Familiarity with medical terminology, self funding or ERISA requirements.


Education

  • Associate Degree or High School Diploma/GED and equivalent experience.

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

  • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

  • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

  • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 03/06/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.