[Hiring] Supervisor, Credentialing Quality @CVS Health

Role Description

The Credentialing Quality Supervisor oversees the day-to-day activities of the Senior Credentialing Specialists who are responsible for auditing the quality and accuracy of all applications reviewed by our credentialing team. You will play a critical role in maintaining our high standards by ensuring error-free processing and compliance. The Supervisor will maintain strong cross-departmental relationships with Credentialing Operations, Recruiting, and Compliance. This role will report to our Operations Manager.

Diversity and Inclusion are core values at Signify Health and fostering a workplace culture reflective of that is critical to our continued success as an organization.

What will you do?

• Oversee Quality Operations: Manage the daily workflow of the Senior Audit Specialists to ensure timely and accurate completion of quality reviews for all credentialing and re-credentialing applications.
• Reporting (KPIs and Metrics): Responsible for pulling and analyzing regular reports to monitor team performance and operational metrics. Utilize specific internal systems to extract data, identify trends, and provide actionable insights to leadership.
• Ensure Compliance: Oversee the audit process to ensure provider files strictly adhere to Federal, State, NCQA, and client policy requirements associated with delegated credentialing.
• Team Leadership: Provide guidance, coaching, and regular performance feedback to the senior audit team to align with individual, department, and company goals.
• Training & Development: Train new Senior Specialists on the credentialing audit process, quality standards, error-reporting procedures, and NCQA guidelines. Meet with Ops Mgr regularly to provide updates, reporting, and feedback.
• Drive Continuous Improvement: Analyze audit data to identify error trends, processing bottlenecks, and training opportunities for the broader credentialing team to improve overall quality.
• Act as an Escalation Point: Serve as the final reviewer for complex credentialing audits, discrepancies, or appeals regarding additional verifications (such as State Board Licenses and Department of Defense requests).
• Project Management: Lead and assist with special projects to support quality operations and operational needs as directed by management.

Qualifications

• 2 to 5 years leadership experience
• 3 to 5 years of successful work experience, preferably in a credentialing/auditing role
• 2 to 3 years’ experience in stakeholder management, demonstrating active listening skills and strong interpersonal skills
• Must be familiar with NCQA accreditation standards
• 3 to 5 years of experience using reporting tools including Excel and Power BI
• Technical Skills: Intermediate proficiency in G-Suite (Docs, Sheets, Slides, etc.)
• Attention to Detail: Uncompromising attention to detail and accuracy, with an analytical mindset for spotting errors
• Strict adherence to HIPAA regulations regarding Protected Health Information (PHI)

Preferred Qualifications

• Previous experience in credentialing quality assurance, auditing, or as a Senior Credentialing Specialist, with a deep understanding of NCQA credentialing standards
• Proven experience leading a team, with a focus on fostering a collaborative and productive work environment preferred
• Flexibility: The ability to work overtime as needed to meet audit deadlines

Education

• High school diploma or equivalent required
• Preferred Education: Associate’s degree or equivalent combination of education and experience

Anticipated Weekly Hours

• 40

Time Type

• Full time

Pay Range

The typical pay range for this role is: $43,888.00 - $85,068.00. This 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.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources, based on eligibility

We anticipate the application window for this opening will close on: 10/25/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.