Quality Champion: Health Claims & Service

CVS Health; Texas; Hybrid; USD 25,000 - 53,000; 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 Assurance professional to guide the business as a quality champion, measuring and monitoring the quality of claim processing and customer service to impact customer satisfaction and cost management.

The role includes cross-functional audits, standard reviews, and recommending training and quality controls to senior management to drive compliance and efficiency.

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 consistently drive optimal results.
• Conducts standard quality reviews and audits to proactively measure and monitor team compliance with published policies, and procedures, to effectively 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.
• Takes direction to execute techniques, processes, and responsibilities.

Skills

Health insurance knowledge

Excel proficiency

Diagnosis codes familiarity

Education

High School Diploma or GED

Tools

Excel

Job description

CVS Health is seeking a Quality Assurance professional to guide the business as a quality champion, measuring and monitoring the quality of claim processing and customer service to impact customer satisfaction and cost management.

The role includes cross-functional audits, standard reviews, and recommending training and quality controls to senior management to drive compliance and efficiency.