Healthcare Quality Champion – Claims & Service Excellence

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Quality Specialist to champion quality initiatives across claim processing and customer service in Colorado. You will measure and monitor workflow quality, drive improvements, and support audit-driven compliance with regulatory standards.

Collaborating with multiple departments, you will influence change, conduct audits, and identify training needs to enhance service quality and operational efficiency.

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

• Acts as an advocate and subject matter expert guiding the business by serving as a quality champion through measuring and monitoring the quality and effectiveness of work processes in claim processing and customer service that impact customer satisfaction, medical cost management, and operational efficiency.
• Consults cross-functionally with other departments to influence and promote change, to continually deliver quality service to both internal and external customers.
• Performs regular quality audits for service operations for multiple products and platforms to drive full and consistent compliance to all required standards.
• Executes both 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 experience

Medical terminology

Problem solving

Education

High School Diploma or GED

Tools

Excel

Job description

CVS Health is seeking a Quality Specialist to champion quality initiatives across claim processing and customer service in Colorado. You will measure and monitor workflow quality, drive improvements, and support audit-driven compliance with regulatory standards.

Collaborating with multiple departments, you will influence change, conduct audits, and identify training needs to enhance service quality and operational efficiency.