Quality Advocate - Health Insurance Audits & Analytics

CVS Health; Illinois; Ibrido; USD 25.000 - 53.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Descrizione del lavoro

CVS Health in Illinois seeks a Quality Specialist to champion quality across claim processing and customer service. You will guide cross-functional teams to improve customer satisfaction and operational efficiency.

The role includes regular quality audits, policy adherence, and reporting results to senior management. A 40-hour work week with benefits is offered, with opportunities for bonuses based on performance.

Competenze

• 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, formulas).

Mansioni

• Conduct regular quality audits of service operations across products and platforms.
• Consult cross-functionally to influence and promote change and quality improvements.
• Own and report on targeted quality audit projects with recommendations.
• Follow area protocols and act as a SME on workflows, policies, and systems.

Conoscenze

Health insurance experience

Diagnosis codes knowledge

Excel

Formazione

High School Diploma or GED

Strumenti

Excel

Descrizione del lavoro

CVS Health in Illinois seeks a Quality Specialist to champion quality across claim processing and customer service. You will guide cross-functional teams to improve customer satisfaction and operational efficiency.

The role includes regular quality audits, policy adherence, and reporting results to senior management. A 40-hour work week with benefits is offered, with opportunities for bonuses based on performance.