Healthcare Quality Champion - Claims & Service

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

Job summary

CVS Health in the United States is seeking a Sr Quality Specialist advocate to guide the business by measuring the quality of work processes in claim processing and customer service, with impact on customer satisfaction, medical cost management, and operational efficiency. This role partners cross-functionally to drive continuous improvement, performs audits, and reports findings to senior management.

The position is full-time, 40 hours per week, with a pay range of $18.50–$38.82 per hour and

Qualifications

• 2+ years of health insurance work experience and/or Healthcare Insurance Quality Review.
• 2+ years of experience working 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 under limited supervision, referring deviations from standard practices to managers.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Acts as a subject matter expert on Quality Specialist workflows, policies, systems requirements, and enhancements as well as daily operations and programs to consistently drive optimal results.
• Conducts standard quality reviews and audits to proactively measure and monitor team compliance with published policies, and procedures, to effectively meet customer and regulatory guidelines.
• Owns responsibility for supporting targeted quality audit projects, reporting overall results, and making recommendations regarding training needs, quality controls, and procedures to senior management.
• Takes direction to execute techniques, processes, and responsibilities.

Skills

Health insurance experience

Diagnosis codes & medical terminology

Problem solving

Decision making

Education

High School Diploma or equivalent GED

Tools

Excel

Job description

CVS Health in the United States is seeking a Sr Quality Specialist advocate to guide the business by measuring the quality of work processes in claim processing and customer service, with impact on customer satisfaction, medical cost management, and operational efficiency. This role partners cross-functionally to drive continuous improvement, performs audits, and reports findings to senior management.

The position is full-time, 40 hours per week, with a pay range of $18.50–$38.82 per hour and