Health Quality Champion - Claims & Service

CVS Health; Montana; Hybrid; USD 26.000 - 54.000; Vollzeit

Benefits dieser Stelle

Comprehensive benefits

Zusammenfassung

CVS Health is seeking a Sr. Quality Specialist to advocate for quality across claim processing and customer service. You will measure and monitor work processes to improve customer satisfaction, medical cost management, and operational efficiency.

You will collaborate with other departments to promote change and ensure compliance with standards. The role requires auditing, policy adherence, and acting as a SME on workflows and system requirements to drive optimal results in a complex

Qualifikationen

• 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).
• College degree preferred
• Claims experience
• DG experience

Aufgaben

• Executes regular quality audits for service operations across multiple products and platforms.
• Owns and reports on targeted quality audit projects, recommending training needs and quality controls to senior management.
• Guides cross-functional teams to influence process improvements and productivity.
• Follows area protocols and policies to deliver effective and timely support.

Kenntnisse

Health insurance knowledge

Diagnosis codes

Medical terminology

Excel (V-lookups, pivot tables)

Ausbildung

High School Diploma or GED

Tools

Excel

Jobbeschreibung

CVS Health is seeking a Sr. Quality Specialist to advocate for quality across claim processing and customer service. You will measure and monitor work processes to improve customer satisfaction, medical cost management, and operational efficiency.

You will collaborate with other departments to promote change and ensure compliance with standards. The role requires auditing, policy adherence, and acting as a SME on workflows and system requirements to drive optimal results in a complex