Claim Audit Quality Specialist

CVS Health

1d • $17 - $31

About The Position

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 Claim Audit Quality Analyst is responsible for ensuring the accuracy and quality of claim audits across multiple areas within Meritain. This role demands a deep understanding of claims, plan documents, eligibility, coverages, and the unique requirements of various groups. The analyst will become a subject matter expert, applying detailed review skills and maintaining high standards in a fast-paced, high-production environment.

Requirements

• 1-3 years of claims processing
• 1+ year(s) Knowledge of CPT codes
• 1+ year(s) Knowledge of ICD-10 codes
• Microsoft office experience.

Nice To Haves

• 1–2 years of DG experience
• Strong knowledge of claims processing
• Exceptional attention to detail
• Ability to quickly become a subject matter expert in new areas
• Proven track record of managing workload efficiently in a high-volume environment

Responsibilities

• Conduct thorough audits of claims, ensuring compliance with plan documents and eligibility requirements.
• Analyze and interpret a variety of group-specific guidelines and coverage “quirks”.
• Maintain high accuracy and quality standards while meeting production goals.
• Manage time effectively to balance multiple priorities in a deadline-driven setting.
• Collaborate with team members to share knowledge and resolve complex audit issues.
• Document audit findings clearly and provide actionable feedback.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED