Senior Health Claims Quality Specialist

CVS Health; West Virginia; Híbrido; USD 25.000 - 53.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Descripción de la vacante

CVS Health is seeking a Quality Specialist to advocate for quality in claim processing and customer service. You will measure and monitor work processes, influence cross-functional teams, and drive compliance with standards to improve customer outcomes.

Responsibilities include conducting audits, supporting targeted quality projects, and reporting results to senior management. A high school diploma and experience in health insurance are required, with 40 hours weekly and an annual base pay range

Formación

• 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)

Responsabilidades

• 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
• Conducts standard quality reviews and audits to measure and monitor team compliance with policies and procedures

Conocimientos

Health insurance experience

Diagnosis codes & medical terminology

Excel

Educación

High School Diploma or GED

Descripción del empleo

CVS Health is seeking a Quality Specialist to advocate for quality in claim processing and customer service. You will measure and monitor work processes, influence cross-functional teams, and drive compliance with standards to improve customer outcomes.

Responsibilities include conducting audits, supporting targeted quality projects, and reporting results to senior management. A high school diploma and experience in health insurance are required, with 40 hours weekly and an annual base pay range