Medical Claims QA Specialist

CVS Health; Raleigh (NC); On-site; USD 23,000 - 35,000; Full time

Job summary

CVS Health is hiring for a QA/Test position in Service Operations. The role focuses on creating and executing unit testing processes to audit vendor contracts prior to implementation, and assisting with testing system enhancements.

You will prepare test plans, validate results, and communicate outcomes to end users, acting as a liaison between users and IT. Strong communication and healthcare knowledge are essential.

Qualifications

• 2+ years related experience in a service center medical claims (not RX claims) processing or managed care operational role.
• 1 year recent and related system processing, payment, and benefits experience, preferably IDX managed care.
• Broad knowledge of medical terminology, claims, cost containment, coordination of benefits, diagnosis coding, and customer services sources.
• Excellent verbal and written communication skills.

Responsibilities

• Create and execute defined unit testing processes for vendor contracts prior to implementation.
• Assist with testing simple system enhancements.
• Prepare and execute a comprehensive test plan and scripts for quality audits of vendor contracts.
• Verify system functions meet user requirements and guidelines.

Skills

Medical claims experience

IDX managed care

Communication skills

Education

High School Diploma or GED

Tools

QNXT

Job description

CVS Health is hiring for a QA/Test position in Service Operations. The role focuses on creating and executing unit testing processes to audit vendor contracts prior to implementation, and assisting with testing system enhancements.

You will prepare test plans, validate results, and communicate outcomes to end users, acting as a liaison between users and IT. Strong communication and healthcare knowledge are essential.