Quality Champion for Health Claims & Service

CVS Health; North Carolina; Hybrid; USD 26,000 - 54,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Quality Specialist to act as a subject matter expert, guiding the business by measuring and monitoring the quality of claim processing and customer service. You will influence change to improve customer satisfaction, medical cost management, and operational efficiency.

The role involves cross-functional consultation, audits, and adherence to standards across multiple products and platforms.

Qualifications

• 2+ years of health insurance work experience or Healthcare Insurance Quality Review.
• 2+ years of experience with diagnosis codes and medical terminology.
• Moderate to advanced knowledge of Excel (V-lookups, pivot tables, formulas).

Responsibilities

• Executes routine and non-routine business support tasks for the Sr Quality Specialist area under limited supervision.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Acts as a SME on Quality Specialist workflows, policies, systems requirements, and enhancements.
• Conducts standard quality reviews and audits to measure compliance with policies and procedures.
• Owns responsibility for supporting targeted quality audit projects and reporting results to senior management.
• Takes direction to execute techniques, processes, and responsibilities.

Skills

Health insurance experience

Diagnosis codes knowledge

Excel proficiency

Education

High School Diploma or GED

Job description

CVS Health is seeking a Quality Specialist to act as a subject matter expert, guiding the business by measuring and monitoring the quality of claim processing and customer service. You will influence change to improve customer satisfaction, medical cost management, and operational efficiency.

The role involves cross-functional consultation, audits, and adherence to standards across multiple products and platforms.