Senior Quality Specialist, CVS Health

CVS Health

Location:
United States

Category:
Quality Control

Contract Type:
Employment contract

Salary:

18.50 - 42.35 USD / Hour

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Job 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.

Job Responsibility:

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
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
Acts as a subject matter expert on Quality Specialist workflows, policies, systems requirements, and enhancements
Conducts standard quality reviews and audits to proactively measure and monitor team compliance with published policies, and procedures
Owns responsibility for supporting targeted quality audit projects, reporting overall results, and making recommendations regarding training needs, quality controls, and procedures to senior management

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)
High School Diploma or equivalent GED

Nice to have:

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

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation and weight management programs
Confidential counseling
Financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
November 23, 2025

Expiration:
December 23, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Senior Quality Specialist