Health Insurance Quality Leader (Claims & Service)

CVS Health; Wisconsin; Hybrid; USD 25,000 - 53,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Wellness program

Job summary

CVS Health is seeking a Quality Assurance specialist to advocate for quality across claim processing and customer service. You will guide improvements by measuring quality, auditing processes, and partnering with cross-functional teams to drive consistent customer satisfaction and operational efficiency.

The role requires health insurance quality experience, DX code knowledge and strong Excel skills. This is a full-time position with comprehensive benefits and opportunity to impact care quality

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.
• Follows area protocols, standards and policies to provide effective and timely support.
• Acts as a subject matter expert on Quality Specialist workflows and systems requirements.
• Conducts standard quality reviews and audits to measure team compliance with policies and procedures.
• Owns responsibility for supporting targeted quality audit projects and reporting results.
• Takes direction to execute techniques, processes, and responsibilities.

Skills

Quality audits

Analytical thinking

Excel proficiency

Education

High School Diploma or GED

Tools

Excel

Job description

CVS Health is seeking a Quality Assurance specialist to advocate for quality across claim processing and customer service. You will guide improvements by measuring quality, auditing processes, and partnering with cross-functional teams to drive consistent customer satisfaction and operational efficiency.

The role requires health insurance quality experience, DX code knowledge and strong Excel skills. This is a full-time position with comprehensive benefits and opportunity to impact care quality