Senior Quality Champion: Healthcare Claims

CVS Health; Rhode Island; Híbrido; USD 25.000 - 53.000; Jornada completa

Descripción de la vacante

CVS Health is seeking a Quality Specialist Advocate to guide claim processing and customer service quality initiatives. You will measure and monitor processes to improve customer satisfaction, medical cost management, and operational efficiency, collaborating across departments to drive change.

You will conduct regular quality audits across products and platforms, support targeted audit projects, and report findings to senior management.

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

• Guides the business as a quality champion by measuring and monitoring quality of work processes in claim processing and customer service that impact customer satisfaction, medical cost management, and operational efficiency.
• Consults cross-functionally with other departments to influence and promote change, to continually deliver quality service to both internal and external customers.
• Performs regular quality audits for service operations for multiple products and platforms to drive full and consistent compliance to all required standards.
• Executes 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.

Conocimientos

Health insurance experience

Diagnosis codes

Medical terminology

Educación

High School Diploma or equivalent GED

Herramientas

Excel

Descripción del empleo

CVS Health is seeking a Quality Specialist Advocate to guide claim processing and customer service quality initiatives. You will measure and monitor processes to improve customer satisfaction, medical cost management, and operational efficiency, collaborating across departments to drive change.

You will conduct regular quality audits across products and platforms, support targeted audit projects, and report findings to senior management.