Health Insurance Quality Advocate & Claims Auditor

CVS Health

Florida

Hybrid

USD 25,000 - 53,000

Full time

5 days ago

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Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health in Florida is seeking a Quality Specialist advocate to measure and monitor the quality and effectiveness of work processes in claim processing and customer service. You will influence cross-functional teams and perform audits to ensure service quality and regulatory compliance.

The role supports senior management with insights, improvements, and training recommendations, while following established policies and procedures.

Qualifications

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).

Responsibilities

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 subject matter expert on Quality Specialist workflows, policies, systems requirements, and enhancements.
Conducts standard quality reviews and audits to ensure compliance with policies and procedures.
Owns responsibility for targeted quality audit projects, reporting results, and recommending training needs and procedures.
Takes direction to execute techniques, processes, and responsibilities.