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About the Role

Acts as an advocate and subject matter expert guiding the business by serving as a quality champion through measuring and monitoring the quality and effectiveness of work processes in claim processing and customer service that impact customer satisfaction, medical cost management, and operational efficiency.

Responsibilities

• Consults cross-functionally with other departments to influence and promote change, to continually deliver quality service to both internal and external customers.
• Performs regular quality audits for service operations for multiple products and platforms to drive full and consistent compliance to all required standards.
• Executes both routine and non-routine business support tasks for the Sr Quality Specialist area under limited supervision, referring deviations from standard practices to managers.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Acts as a subject matter expert on Quality Specialist workflows, policies, systems requirements, and enhancements as well as daily operations and programs to consistently drive optimal results.
• Conducts standard quality reviews and audits to proactively measure and monitor team compliance with published policies, and procedures, to effectively meet customer and regulatory guidelines.
• Owns responsibility for supporting targeted quality audit projects, reporting overall results, and making recommendations regarding training needs, quality controls, and procedures to senior management.
• Takes direction to execute techniques, processes, and responsibilities.

Requirements

• 2+ years of health insurance work experience and/or Healthcare Insurance Quality Review
• 2+ years of experience working with diagnosis codes and medical terminology.
• Moderate to advanced knowledge of Excel (V-lookups, pivot tables, and/or formulas)
• Working knowledge of problem solving and decision making skills

Work Type

• Full time

Education Level

• High School Diploma or equivalent GED
• College degree preferred

Salary/Compensations

• $18.50 - $38.82

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs

About the Company

• 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.
• 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.

Equal Opportunity

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