Quality Specialist

CVS Health; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Claim Audit Quality Analyst to join their team. This role demands a keen eye for detail and expertise in claims, eligibility, and coverage nuances. As a vital part of the auditing process, you'll ensure quality standards are met while managing your workload in a fast-paced environment. The company offers a supportive workplace with a commitment to health and wellness, making it an exciting opportunity for those looking to advance their careers in the health sector.

Benefits

401(k) plan with matching contributions

Employee stock purchase plan

Affordable medical plan options

Flexible schedules

Tuition assistance

Paid time off

Wellness screenings

Confidential counseling

Financial coaching

Qualifications

• Must have a wide depth of knowledge in claims and eligibility.
• Ability to manage time effectively in a high production environment.

Responsibilities

• Become subject matter experts in claims and plan documents.
• Maintain high quality standards while auditing claims.

Skills

Claims experience

Knowledge of CPT codes

Knowledge of ICD-10 codes

Education

High school diploma or equivalent

Job description

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues—caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. And we do it all with heart, each and every day.

Position Summary

Claim Audit Quality Analysts need to have a wide depth and breadth of knowledge of several different areas within Meritain. The role requires a high level of detail and review. A candidate must become subject matter experts in claims, plan documents, eligibility, coverages, and quirks of multiple groups. Knowledge in all these areas is imperative to be an effective auditor. The QA analyst must be able to effectively manage their time and work in a high production environment, while maintaining high quality standards.

Required Qualifications

• 1-2 years of Claims experience
• 1+ year of knowledge of CPT codes
• 1+ year of knowledge of ICD-10 codes

Preferred Qualifications

• 3-4 years of claims experience

Education

High school diploma or equivalent

Additional Details

• Anticipated Weekly Hours: 40
• Time Type: Full time
• Pay Range: $17.00 - $28.46 per hour

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above.

Benefits

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional, and financial wellness of our colleagues and their families. Our benefits include:

• Affordable medical plan options, a 401(k) plan (including matching contributions), and an employee stock purchase plan.
• No-cost programs such as wellness screenings, tobacco cessation, weight management, confidential counseling, and financial coaching.
• Benefit solutions tailored to diverse needs including paid time off, flexible schedules, family leave, dependent care resources, tuition assistance, retiree medical access, and more.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

Application deadline: 05/12/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.

About the company

At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans, and community pharmacists, we’re pioneering a bold new approach to total health—making quality care more affordable, accessible, simple, and seamless to help people stay well in body, mind, and spirit.