Top 80 Complaint & appeal analyst Jobs

Senior Analyst, Provider Relations (Metro NY)
CVS Health —Trenton, NJ
- $46,988 - $122,400 a year
- Full-time
- HIPAA
- Research
- Mid-level
- Health insurance
- Dental insurance
8d
Senior Analyst, Provider Relations (Metro NY)
CVS Health —New York, NY
- $46,988 - $122,400 a year
- Full-time
- HIPAA
- Research
- Mid-level
- Health insurance
- Dental insurance
9d
Human Resources Analyst – Labor and Employee Relations Division (Clerk of the Court and Comptroller)
Miami-Dade County —Miami-Dade County, FL
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Grievance & Appeal Analyst
Verda Healthcare Inc —Huntington Beach, CA
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- Weekends as needed
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Human Resouces Analyst (1241) - Multiple Departments Citywide (C00183)
City and County of San Francisco —San Francisco, CA
- Online Application
- Hybrid work
- Mid-level
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- Bachelor's degree
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Sr. Analyst, Regulatory Complaints
Oscar Health —Remote
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- Mid-level
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8d
Human Resources Analyst
City of Compton, CA —Compton, CA
- $95,369.70 - $111,817.20 a year
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Zoning Analyst
Richland County Government —Richland County, SC
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- Weekends as needed
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Senior Human Resources Analyst (1244) - Multiple Departments Citywide (C00184)
City and County of San Francisco —San Francisco, CA
- $139,828 - $169,858 a year
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- Master's degree
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Quality Assurance Analyst
University of California, Irvine —Irvine, CA
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Cryptocurrency Analyst
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Analyst, Prospect Strategy
Western Kentucky University —Bowling Green, KY
- $39,100 - $45,000 a year
- Full-time
- Microsoft Excel
- Computer literacy
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Grievance and Appeals Analyst I
Solis Health Plans —Doral, FL
- $22 - $24 an hour
- Weekends as needed
- Ability to walk for extended periods
- Research
- Mid-level
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Sr. Reimbursement Analyst
ECU Health —Greenville, NC
- $68,806.40 - $100,294.48 a year
- Weekends as needed
- Remote
- Customer service
- 5 years
- Bachelor's degree
Financial Aid Analyst
Wright State University —Dayton, OH
- Computer literacy
- Mid-level
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Risk and Patient Experience Analyst
San Ysidro Health —San Diego, CA
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- Weekends as needed
- Microsoft Excel
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Memphis Shelby County Schools —Memphis, TN
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ANALYST II
Department of Developmental Services - Headquarters —Sacramento County, CA
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ERP Master Data Analyst
Hawaii Health Systems Corp —Honolulu, HI
- $69,181 a year
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FOIA ANALYSTS-Mid
Client Server Software Solutions —Washington, DC
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- 3 years
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Senior Analyst, Provider Relations (Metro NY)

CVS Health -
Trenton, NJ

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Job Details

Full-time
$46,988 - $122,400 a year
8 days ago

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Research
Productivity software
Medical terminology

Full Job Description

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 complex provider-facing workflows, inquiries, and escalations across claims, enrollment, contracting, and regulatory functions. This role serves as a key liaison between providers (including physicians and allied healthcare professionals) and internal operations, leveraging strong analytical capabilities to investigate issues, drive resolution, and ensure compliance with regulatory and network requirements. Position is primarily remote with willingness to travel to office as needed.

Key Role Responsibilities

Manage complex provider inquiries, escalations, and operational requests across claims, enrollment, and regulatory domains
Conduct detailed research and analysis of provider disputes, including claims and policy-related issues
Investigate and respond to executive-level, Department of Insurance (DOI), and medical society complaints
Research and resolve member or plan sponsor disputes escalated by Sales or Account Management teams
Facilitate provider termination appeals and incorrect participation corrections
Coordinate provider contract adjustment requests in partnership with contracting teams
Support provider enrollment and demographic updates (e.g., TIN changes, address updates, effective dates)
Escalate and track credentialing and recredentialing issues, including non-responder follow-up
Facilitate HIPAA-related updates and compliance-related provider requests
Provide and interpret complete provider participation rosters for large provider groups
Conduct network directory validation and maintenance activities
Identify and support resolution of network deficiency gaps, including provider recruitment support
Assist with fraud, waste, and abuse (FWA) investigations
Support Medicare eligibility audits, network audits (including Metro NY), and sponsor audit requests
Participate in quarterly network filing activities and regulatory submissions
Support chart collection, HEDIS, and Risk Adjustment validation initiatives
Assist root cause analysis efforts, including roster accuracy and SAI-related clean-up
Analyze operational data trends to identify process improvement opportunities and recurring issues
Deliver targeted outreach and follow-up to improve provider compliance and data accuracy
Educate providers on administrative processes and self-service tools to improve efficiency and accuracy

Required Qualifications

2-5 years of professional work experience, 1 year in the healthcare industry
Experience with medical terminology
Experience working with Microsoft Office Suite
Ability to travel in the Metro NY Territory as needed
Proven ability to manage multiple workflows, prioritize effectively, and meet deadlines
Strong written and verbal communication skills, with the ability to convey complex information clearly

Preferred Qualifications

Demonstrated experience working with physicians and other healthcare providers
Strong analytical and problem-solving skills with the ability to interpret complex data and resolve issues
Triage member and provider issues (e.g., COB, eligibility, plan setup, pending claims) to appropriate teams to ensure timely resolution
Build and maintain strong, professional relationships with internal stakeholders and external provider partners
Perform root cause analysis on recurring provider issues, identifying opportunities for process improvement and policy alignment
Collaborate cross-functionally to resolve escalated issues impacting providers or operational workflows
Ensure adherence to contract terms, payment policies, and regulatory requirements
Engage directly with key providers as needed to support service levels and address concerns

Education

High School Degree or Commensurate Experience

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $122,400.00

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: 07/29/2026

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

Apply Now

Refine Your Search

complaint & appeal analyst jobs

Senior Analyst, Provider Relations (Metro NY)

Senior Analyst, Provider Relations (Metro NY)

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Grievance & Appeal Analyst

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Senior Human Resources Analyst (1244) - Multiple Departments Citywide (C00184)

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Risk and Patient Experience Analyst

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ANALYST II

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FOIA ANALYSTS-Mid

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