Claim Audit Quality Specialist

CVS Health

23h • $17 - $34

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 The Claim Audit Quality Specialist will audit pre- and post-payment claims for accuracy and eligibility transactions. They will also be responsible for identifying errors, necessary corrective measures, and may participate in special audit assignments. In this role, you will: Work consistently out of a production queue, auditing any assigned claims. Oversee the completion several reviews a day, utilizing plan documents as a primary source. Utilize DG system to complete all reviews. Complete various tasks as assigned by team leads, and attend internal meetings as needed. Collaborate with internal account representatives and/or claims examiners as needed.

Requirements

• 1+ year of experience working in a health care setting.
• At least 6 months of experience with interpreting and understanding of plan documents.
• Demonstrated knowledge of Microsoft Excel.
• High school diploma or GED.

Nice To Haves

• 1-2 years of claims processing experience.
• 1-2 years of auditing experience.
• Ability to succeed in a production driven environment, managing multiple tasks while shifting priorities and maintaining a high work volume.
• Excellent verbal and written communication skills, with the ability to interact effectively and courteously.
• Ability to work with minimal guidance while delivering accurate and timely results.
• Strong time management, attention to detail, and organizational skills.
• Team-oriented personality.

Responsibilities

• Work consistently out of a production queue, auditing any assigned claims.
• Oversee the completion several reviews a day, utilizing plan documents as a primary source.
• Utilize DG system to complete all reviews.
• Complete various tasks as assigned by team leads, and attend internal meetings as needed.
• Collaborate with internal account representatives and/or claims examiners as needed.

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