Health Insurance Quality Advocate

CVS Health; Montgomery (AL); Presencial; USD 25.000 - 53.000; Jornada completa

Descripción de la vacante

CVS Health is seeking a Sr Quality Specialist to guide quality initiatives across claim processing and customer service. You will measure and monitor work processes and drive compliance with standards, partnering with multiple departments to improve customer satisfaction and reduce costs.

You will perform regular quality audits, support training and quality controls, and help ensure programs meet regulatory guidelines while advancing operational efficiency in a fast-paced environment.

Formación

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

Responsabilidades

• Executes routine and non-routine business support tasks for the Sr Quality Specialist area under limited supervision.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Acts as a SME on Quality Specialist workflows, policies, systems requirements, and enhancements to drive optimal results.
• Conducts standard quality reviews and audits to measure team compliance with policies and procedures.
• Owns responsibility for targeted quality audit projects, reporting results, and suggesting training needs and quality controls to senior management.
• Takes direction to execute techniques, processes, and responsibilities.

Conocimientos

Excel advanced (V-lookups, pivot, and/

Quality assurance

Healthcare insurance knowledge

Problem solving

Educación

High School Diploma or GED

College degree preferred

Descripción del empleo

CVS Health is seeking a Sr Quality Specialist to guide quality initiatives across claim processing and customer service. You will measure and monitor work processes and drive compliance with standards, partnering with multiple departments to improve customer satisfaction and reduce costs.

You will perform regular quality audits, support training and quality controls, and help ensure programs meet regulatory guidelines while advancing operational efficiency in a fast-paced environment.