Health Insurance Quality Champion & Claims Expert

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

Vantaggi offerti da questo lavoro

Medical Insurance

Dental Insurance

Vision Insurance

Paid Time Off

Retirement Savings

Descrizione del lavoro

CVS Health is seeking a Sr Quality Specialist advocate to guide business processes, measure quality, and drive customer satisfaction across claims processing and service operations.

You will consult cross-functionally, perform audits, and help shape quality programs that improve efficiency, regulatory compliance, and patient outcomes. This role emphasizes data-driven analysis and collaboration with multiple departments.

Competenze

• 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).

Mansioni

• Executes 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.

Conoscenze

Health insurance knowledge

Diagnosis codes knowledge

Excel skills

Formazione

High School Diploma or GED

Descrizione del lavoro

CVS Health is seeking a Sr Quality Specialist advocate to guide business processes, measure quality, and drive customer satisfaction across claims processing and service operations.

You will consult cross-functionally, perform audits, and help shape quality programs that improve efficiency, regulatory compliance, and patient outcomes. This role emphasizes data-driven analysis and collaboration with multiple departments.