Senior Quality Specialist

This is a fully remote position, open to applicants in Alabama, +34 more states.

📋 Description

• Serve as an advocate and expert, guiding the organization as a champion of quality.

• Assess and oversee the quality and efficiency of claim processing and customer service workflows.

• Collaborate with various departments to drive and encourage change.

• Conduct regular quality audits for service operations across a range of products and platforms.

• Carry out routine and non-routine business support tasks with minimal supervision.

• Adhere to established area protocols, standards, and policies.

• Act as a subject matter expert on workflows, policies, system requirements, enhancements, daily operations, and programs.

• Perform standard quality reviews and audits to ensure compliance with established policies and procedures.

• Assist with targeted quality audit initiatives, report overall results, and suggest training needs, quality controls, and procedures to senior management.

• Implement assigned techniques, processes, and responsibilities.

⛳️ Requirements

• Minimum of 2 years of experience in health insurance and/or Healthcare Insurance Quality Review.

• At least 2 years of experience with diagnosis codes and medical terminology.

• Moderate to advanced proficiency in Excel, including V-lookups, pivot tables, and/or formulas.

• High School Diploma or equivalent GED required.

• Familiarity with problem-solving and decision-making skills.

• Experience in claims processing.

• Experience with DG.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being, subject to eligibility.