Quality Champion: Claims & Customer Service Audits

CVS Health

Arkansas

Hybrid

USD 25,000 - 53,000

Full time

5 days ago

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Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Quality Specialist to advocate for quality in claim processing and customer service. You will measure, monitor, and improve work processes, audits, and compliance across multiple products and platforms.

You will collaborate with cross-functional teams to influence changes that enhance customer satisfaction, medical cost management, and operational efficiency. A strong Excel skillset and health insurance experience are essential.

Qualifications

2+ years of health insurance experience or Healthcare Insurance Quality Review.
2+ years of experience with diagnosis codes and medical terminology.
Advanced Excel skills including VLOOKUPs, pivot tables, and formulas.

Responsibilities

Acts as quality champion by measuring and monitoring quality and effectiveness of work processes in claim processing and customer service.
Consults cross-functionally to influence and promote changes for quality service.
Performs regular quality audits for service operations to drive compliance with standards.
Owns support for targeted quality audit projects and reports results to senior management.
Takes direction to execute processes and responsibilities as required.