Health Insurance Quality Auditor & Process Champion

CVS Health; Charlotte (NC); On-site; USD 25,000 - 53,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in Charlotte, NC seeks a Senior Quality Specialist to champion quality in claim processing and customer service. You will measure the effectiveness of work processes impacting customer satisfaction and cost management, consulting cross-functionally to drive improvements.

The role requires 2+ years in health insurance QA, experience with diagnosis codes, and strong Excel skills. This full-time position offers a comprehensive benefits package and growth opportunities within CVS Health.

Qualifications

• 2+ years 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).

Responsibilities

• Executes routine and non-routine business support tasks 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 proactively measure and monitor team compliance with published policies and procedures.
• Owns responsibility for supporting targeted quality audit projects, reporting overall results, and making recommendations to senior management.
• Takes direction to execute techniques, processes, and responsibilities.

Skills

Health insurance experience

Diagnosis codes knowledge

Excel proficiency

Education

High School Diploma or GED

College degree preferred

Job description

CVS Health in Charlotte, NC seeks a Senior Quality Specialist to champion quality in claim processing and customer service. You will measure the effectiveness of work processes impacting customer satisfaction and cost management, consulting cross-functionally to drive improvements.

The role requires 2+ years in health insurance QA, experience with diagnosis codes, and strong Excel skills. This full-time position offers a comprehensive benefits package and growth opportunities within CVS Health.