Quality Assurance Lead – Health Claims

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Sr Quality Specialist to act as a quality champion, measuring and monitoring processes in claim processing and customer service to improve satisfaction and efficiency.

You will consult cross-functionally, conduct audits, and drive compliance with standards, policies, and regulations across multiple products and platforms. This role emphasizes data-driven improvements and collaboration with senior management.

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 drive optimal results.
• Conducts standard quality reviews and audits to measure and monitor team compliance with published policies and procedures to 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.

Skills

Health insurance knowledge

Diagnosis codes

Excel

Education

High School Diploma or GED

Job description

CVS Health is seeking a Sr Quality Specialist to act as a quality champion, measuring and monitoring processes in claim processing and customer service to improve satisfaction and efficiency.

You will consult cross-functionally, conduct audits, and drive compliance with standards, policies, and regulations across multiple products and platforms. This role emphasizes data-driven improvements and collaboration with senior management.