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Quality Assurance Analyst, Audit Control I
CVS Health. Perform quality audits for service operations across multiple products and platforms .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicare and Medicaid High Dollar Claim Processing, ensuring compliance with SOX and SOC1 standards while delivering accurate performance guarantee reporting. Possesses strong analytical and communication skills to promote quality improvement and exceed customer expectations.
Highest-signal resume keywords
Medicare High Dollar Claim ProcessingMedicaid High Dollar Claim ProcessingSOX ComplianceSLA ReportingPerformance Guarantee Reporting
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Quality AuditsPerformance Metric ReportingInternal Audit ControlsQuality ImprovementData Analysis
Soft Skills
Effective CommunicationOrganizational SkillsProblem SolvingAdaptabilityCustomer-Focused
Certifications & Qualifications
High School DiplomaG.E.D.
Industry Keywords
MedicareMedicaidService Level AgreementsCompliance ControlsCustomer Expectations
About the role
Key responsibilities & impact- Perform quality audits for service operations across multiple products and platforms
- Serve as the official source for Customer/Plan Sponsor performance guarantee reporting
- Support SOX and SOC1, Internal Audit/Compliance controls
- Serve as the official source for Service Level Agreements (SLA) for vendors and Book of Business reporting
- Promote quality improvement, trending, and training opportunities
- Provide customer performance guarantee and key performance metric reporting
- Support SOX and Sarbanes controls for Medicare and Medicaid claim processing
- Anticipate and exceed customer expectations
- Work toward quality and production goals
Requirements
What you’ll need- 1 year Medicare or Medicaid High Dollar Claim Processing Experience
- Fully trained in Medicare or Medicaid High Dollar claim processing
- Comfortable with quality and production goals
- High School Diploma or equivalent G.E.D.
- Knowledge of Medicare and Medicaid e.policies (preferred)
- High proficiency in processing Medicare or Medicaid High Dollar claims (preferred)
- Effective verbal and written communication skills
- Analytical, organizational, and problem solving skills
- Ability to adapt quickly and willingly to change
- Positive attitude
- Customer-focused and team-oriented approach
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