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
40Time Type
Full timePay Range
The typical pay range for this role is:
$18.50 - $38.82This pay 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 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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 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)
- Working knowledge of problem solving and decision making skills
- College degree
- Claims experience
- DG experience
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
