Quality Champion — Health Insurance Claims & Service

CVS Health

Indiana

Hybrid

USD 25,000 - 53,000

Full time

5 days ago

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Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health in Indiana is seeking a Quality Assurance Specialist to advocate for high standards in claims processing and customer service. You will conduct audits, monitor processes, and collaborate across departments to improve quality and compliance. This full-time role offers comprehensive benefits and opportunities to influence care quality.

Ideal candidates have 2+ years in health insurance quality reviews, familiarity with diagnosis codes, and strong Excel skills for data analysis.

Qualifications

2+ years of health insurance work experience.
2+ years of experience working with diagnosis codes and medical terminology.
Proficient in Excel (V-lookups, pivot tables, and formulas).

Responsibilities

Executes 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 subject matter expert on Quality Specialist workflows, policies, systems requirements, and enhancements.
Conducts standard quality reviews and audits to measure and monitor team compliance with policies and procedures.
Owns responsibility for supporting targeted quality audit projects, reporting results, and recommending training needs and controls.
Takes direction to execute techniques, processes, and responsibilities.