Senior Quality Specialist

CVS Health

2d•Onsite

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 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.

Requirements

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)

Nice To Haves

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

Responsibilities

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.