Healthcare Claims QA Specialist

CVS Health; North Carolina; Hybrid; USD 23,000 - 35,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in North Carolina seeks a thorough Tester to develop and execute testing for claims, enrollment, provider contracts and benefits administration. You will create and run test plans, validate results, and coordinate sign-offs with end users and IT in a full-time Service Operations role.

Ideal candidates bring 2+ years in medical claims processing or managed care operations, plus experience in system processing and benefits.

Qualifications

• 2+ years in a service center medical claims or managed care operations.
• 1 year recent system processing, payment, and benefits experience, preferably IDX.
• Broad knowledge of medical terminology, claims, COB, diagnosis coding, and customer service.
• Excellent verbal and written communication skills.

Responsibilities

• Develops and executes comprehensive testing processes for system enhancements across claims, enrollment, provider contracts and benefits administration.
• Prepares and executes test plans and scripts; validates results and documents discrepancies to ensure quality.
• Acts as liaison between end users and the IT team; reports progress and coordinates sign-off on results.
• Performs other duties as required within Service Operations.

Skills

Medical claims

Customer service

Communication skills

Education

High School Diploma or GED

Job description

CVS Health in North Carolina seeks a thorough Tester to develop and execute testing for claims, enrollment, provider contracts and benefits administration. You will create and run test plans, validate results, and coordinate sign-offs with end users and IT in a full-time Service Operations role.

Ideal candidates bring 2+ years in medical claims processing or managed care operations, plus experience in system processing and benefits.