Healthcare Quality Champion — Claims & Service

CVS Health; Kansas; Híbrido; USD 25.000 - 53.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision coverage

Descripción de la vacante

CVS Health is seeking a Quality Reviewer to champion the quality of claim processing and customer service. You will audit, measure, and influence improvements to ensure regulatory and internal standards are met.

You will collaborate across departments, conduct audits, and provide training recommendations. This full-time role offers competitive benefits and opportunities to impact patient care.

Formación

• 2+ years of health insurance work experience 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).

Responsabilidades

• Executes routine and non-routine business support tasks for the Sr Quality Specialist area under limited supervision, referring deviations to managers.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Acts as a SME on Quality Specialist workflows, policies, systems requirements, and enhancements as well as daily operations and programs.
• Conducts standard quality reviews and audits to proactively measure and monitor team compliance with published policies and procedures.
• Owns responsibility for supporting targeted quality audit projects, reporting results, and making recommendations to senior management.
• Takes direction to execute techniques, processes, and responsibilities.

Conocimientos

Health insurance experience

Diagnosis codes

Excel

Educación

High School Diploma or GED

Descripción del empleo

CVS Health is seeking a Quality Reviewer to champion the quality of claim processing and customer service. You will audit, measure, and influence improvements to ensure regulatory and internal standards are met.

You will collaborate across departments, conduct audits, and provide training recommendations. This full-time role offers competitive benefits and opportunities to impact patient care.