Quality Champion, Health Insurance Claims

CVS Health; Philadelphia (Philadelphia County); Sur place; USD 25 000 - 53 000; Plein temps

Avantages offerts par ce poste

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Bonus eligibility

Résumé du poste

CVS Health is seeking a Quality Specialist to champion quality across claim processing and customer service. You will conduct audits, measure compliance, and collaborate with multiple teams to improve customer satisfaction and reduce costs.

The role requires health insurance experience, familiarity with diagnosis codes, and strong Excel skills. This full-time position offers comprehensive benefits and a path for career growth in a supportive environment.

Qualifications

• 2+ years in health insurance quality review or related work.
• Experience with diagnosis codes and medical terminology.
• Proficient in Excel (V-lookups, pivots, formulas).

Responsabilités

• Act as quality champion monitoring work processes to improve customer satisfaction and efficiency.
• Conduct regular quality audits across claim processing and customer service.
• Coordinate with cross-functional teams to drive adherence to standards.
• Support targeted quality audit projects and report findings to senior management.
• Follow area protocols and escalate deviations to managers.
• Apply knowledge of workflows, policies and systems to optimize outcomes.

Connaissances

Health insurance exp

Diagnosis codes exp

Excel proficient

Formation

High school diploma or GED

College degree preferred

Description du poste

CVS Health is seeking a Quality Specialist to champion quality across claim processing and customer service. You will conduct audits, measure compliance, and collaborate with multiple teams to improve customer satisfaction and reduce costs.

The role requires health insurance experience, familiarity with diagnosis codes, and strong Excel skills. This full-time position offers comprehensive benefits and a path for career growth in a supportive environment.