Senior Quality Specialist

CVS Health Careers

. Act as a quality champion and subject matter expert for claim processing and customer service processes .

Posted 10/30/2026full-timeRemote • Minnesota • United StatesSenior💰 $19 - $39 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in quality assurance and claims processing within the healthcare insurance sector, with a strong focus on compliance, customer satisfaction, and operational efficiency. Proficient in conducting audits, analyzing data, and recommending improvements to enhance service quality.

Highest-signal resume keywords

Healthcare Insurance Quality ReviewClaims ExperienceDiagnosis Codes KnowledgeQuality AuditsExcel Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality AuditsClaims ProcessingDiagnosis CodesMedical TerminologyExcel V-LookupsExcel Pivot TablesExcel FormulasQuality ControlData AnalysisCompliance Monitoring

Soft Skills

Problem SolvingDecision MakingCross-Functional CollaborationInfluencing ChangeCustomer Service

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Healthcare InsuranceQuality AssuranceOperational EfficiencyCustomer SatisfactionMedical Cost Management

About the role

Key responsibilities & impact

Act as a quality champion and subject matter expert for claim processing and customer service processes
Measure and monitor quality and effectiveness of work processes impacting customer satisfaction, medical cost management, and operational efficiency
Consult cross-functionally to influence and promote change and deliver quality service to internal and external customers
Perform regular quality audits for service operations across multiple products and platforms
Execute routine and non-routine business support tasks under limited supervision
Follow area protocols, standards, and policies
Support Quality Specialist workflows, policies, system requirements, enhancements, daily operations, and programs
Conduct quality reviews and audits to monitor compliance with published policies and procedures
Support targeted quality audit projects, report results, and recommend training needs, quality controls, and procedures to senior management
Execute assigned techniques, processes, and responsibilities

Requirements

What you’ll need

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, including V-lookups, pivot tables, and/or formulas
High School Diploma or equivalent GED
Working knowledge of problem solving and decision making skills
Claims experience
DG experience
College degree preferred

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
Eligibility for CVS Health bonus, commission or short-term incentive program in addition to base pay