Senior Health Claims Quality & Audit Champion

CVS Health; Minnesota; 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 hiring a Sr Quality Specialist to guide business quality efforts across claim processing and customer service, driving satisfaction and efficiency. You will audit processes, influence cross-functional teams, and ensure adherence to standards.

The role requires experience in health insurance quality review, strong data analysis, and proficiency in Excel. A similar office setting with full-time hours supports collaboration across departments.

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.
• 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 drive optimal results.
• Conducts standard quality reviews and audits to measure and monitor team compliance with policies and procedures to meet customer and regulatory guidelines.
• Owns responsibility for supporting targeted quality audit projects, reporting results, and recommending training needs and quality controls to senior management.
• Takes direction to execute techniques, processes, and responsibilities.

Skills

Health insurance experience

Diagnosis codes / Medical terminology

Education

High School Diploma or equivalent GED

Tools

Microsoft Excel

Job description

CVS Health is hiring a Sr Quality Specialist to guide business quality efforts across claim processing and customer service, driving satisfaction and efficiency. You will audit processes, influence cross-functional teams, and ensure adherence to standards.

The role requires experience in health insurance quality review, strong data analysis, and proficiency in Excel. A similar office setting with full-time hours supports collaboration across departments.