Complaint & Appeals Analyst (Must reside in Arizona)
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 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. Responsible for compliance with policies of all applicable Federal and/or State government agencies, including but not limited to Center for Medicare and Medicaid Services (CMS) as well as the Arizona Health Care Cost Containment System (AHCCCS).
- 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.
Required Qualifications
- 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.
Preferred Qualifications
- 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.
Education
- High school diploma or GED.
Anticipated Weekly Hours 40 Time Type Full time Pay Range The Typical Pay Range For This Role Is $21.10 - $40.90 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: 06/05/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.