Quality Champion: Health Insurance Claims & Service Excellence

CVS Health; Utah; Hybrid; USD 25,000 - 53,000; Full time

Benefits offered by this job

Health benefits

Job summary

CVS Health is seeking a Sr Quality Specialist advocate to guide the business by measuring and monitoring the quality and effectiveness of work processes in claim processing and customer service. You will influence cross-functional teams to deliver compliant, high-quality service.

The role conducts audits, identifies improvement opportunities, and drives training and process enhancements to optimize customer satisfaction and regulatory compliance.

Qualifications

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

Responsibilities

• Executes both 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

Diagnosis codes

Excel

Education

High School Diploma or GED

Job description

CVS Health is seeking a Sr Quality Specialist advocate to guide the business by measuring and monitoring the quality and effectiveness of work processes in claim processing and customer service. You will influence cross-functional teams to deliver compliant, high-quality service.

The role conducts audits, identifies improvement opportunities, and drives training and process enhancements to optimize customer satisfaction and regulatory compliance.