Senior Quality Specialist

CVS Health; Kentucky; Hybrid; USD 24,796 - 52,348; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Sr Quality Specialist to champion quality across claim processing and customer service. You will measure performance, audit processes, and drive compliance with standards while collaborating with multiple departments to influence improvements.

This role emphasizes data‑driven quality, policy adherence, and operational efficiency in health insurance services. The position requires 2+ years in insurance quality review and strong Excel skills.

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).
• High School Diploma or equivalent GED.

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, procedures, 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 experience

Diagnosis codes & terminology

Excel knowledge

Education

High School Diploma or GED

Tools

DG system experience

Job description

We're building a world of health around every individual – shaping a more connected, convenient and compassionate health experience. At CVS Health® you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

Acts as an advocate and subject‑matter expert guiding the business as a quality champion by measuring and monitoring the quality and effectiveness 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, continuously delivering quality service to both internal and external customers. Performs regular quality audits for service operations across multiple products and platforms to drive full and consistent compliance to all required standards.

Additional 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, procedures, 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.

Required 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).

Preferred Qualifications

• Working knowledge of problem‑solving and decision‑making skills.
• College degree preferred.
• Claims experience.
• DG system experience.

Education

• High School Diploma or equivalent GED.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $18.50 – $38.82 per hour. This 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 experience, education, geography and other relevant factors. The position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above.

Great Benefits for Great People

We offer a comprehensive benefits package designed to support the physical, emotional and financial well‑being of colleagues and their families. Benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 07/21/2026.

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