[Hiring] Senior Quality Specialist @CVS Health

Role Description

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.
• 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.

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)

Requirements

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

Education

• High School Diploma or equivalent GED

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