Senior Quality Specialist- Meritain Health

CVS Health; Philadelphia (Philadelphia County); On-site; USD 25,000 - 53,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Bonus eligibility

Job summary

CVS Health is seeking a Quality Specialist to champion quality across claim processing and customer service. You will conduct audits, measure compliance, and collaborate with multiple teams to improve customer satisfaction and reduce costs.

The role requires health insurance experience, familiarity with diagnosis codes, and strong Excel skills. This full-time position offers comprehensive benefits and a path for career growth in a supportive environment.

Qualifications

• 2+ years in health insurance quality review or related work.
• Experience with diagnosis codes and medical terminology.
• Proficient in Excel (V-lookups, pivots, formulas).

Responsibilities

• Act as quality champion monitoring work processes to improve customer satisfaction and efficiency.
• Conduct regular quality audits across claim processing and customer service.
• Coordinate with cross-functional teams to drive adherence to standards.
• Support targeted quality audit projects and report findings to senior management.
• Follow area protocols and escalate deviations to managers.
• Apply knowledge of workflows, policies and systems to optimize outcomes.

Skills

Health insurance exp

Diagnosis codes exp

Excel proficient

Education

High school diploma or GED

College degree preferred

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 by serving as a quality champion through 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, 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.

Additional Responsibilities to include but not limited to the following:

• 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, 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.

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 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. 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.

Our people fuel our future. Our teams reflect the customers, patients, members, and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people. We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.

The 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: 11/04/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.