Health Insurance Quality Champion & Audit Specialist

CVS Health; Oregon; Ibrido; USD 25.000 - 53.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical

Dental

Vision

Paid time off

Retirement savings

Descrizione del lavoro

CVS Health is seeking a Quality Specialist to act as a quality champion in claim processing and customer service, guiding improvements to meet customer satisfaction and manage medical costs. The role involves auditing work processes, cross-functional consultation, and driving compliance across multiple platforms.

Responsibilities include supporting quality audit projects, reporting results, and recommending training and controls to senior management.

Competenze

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

Mansioni

• Execute routine and non-routine tasks for Sr Quality Specialist area under supervision.
• Follow area protocols to provide effective and timely support.
• Act as SME on Quality workflows, policies, systems and daily ops.
• Conduct standard quality reviews and audits to monitor policy adherence.
• Support targeted quality audit projects and report results to senior management.

Conoscenze

Health insurance experience

Diagnosis codes

Quality review experience

Formazione

High School Diploma or GED

Strumenti

Excel (V-lookups, pivot tables)

Descrizione del lavoro

CVS Health is seeking a Quality Specialist to act as a quality champion in claim processing and customer service, guiding improvements to meet customer satisfaction and manage medical costs. The role involves auditing work processes, cross-functional consultation, and driving compliance across multiple platforms.

Responsibilities include supporting quality audit projects, reporting results, and recommending training and controls to senior management.