Healthcare Quality Champion – Claims & Service

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Job summary

CVS Health in the United States (Nevada) seeks a Sr Quality Specialist to champion quality across claim processing and customer service. You will measure and monitor work processes, influence cross-functional teams, and drive improvements that reduce cost and improve customer satisfaction.

This role requires 2+ years in health insurance quality review, familiarity with diagnosis codes and medical terminology, and strong Excel skills.

Qualifications

• 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 (VLOOKUP, pivot tables, formulas).

Responsibilities

• Executes routine and non-routine business support tasks for the Sr Quality Specialist area under limited supervision.
• 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.
• Conducts standard quality reviews and audits to ensure compliance with policies and procedures.
• Owns reporting results and recommendations for training and quality controls to senior management.
• Performs tasks under direction to execute techniques and responsibilities.

Skills

Healthcare industry experience

Diagnosis codes

Medical terminology

Education

High School Diploma or GED

Tools

Excel (Advanced)

Pivot tables

VLOOKUP

Job description

CVS Health in the United States (Nevada) seeks a Sr Quality Specialist to champion quality across claim processing and customer service. You will measure and monitor work processes, influence cross-functional teams, and drive improvements that reduce cost and improve customer satisfaction.

This role requires 2+ years in health insurance quality review, familiarity with diagnosis codes and medical terminology, and strong Excel skills.