Senior Quality Specialist

CVS Health

. Act as an advocate and subject matter expert guiding the business as a quality champion .

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

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in quality assurance processes within the healthcare insurance sector, focusing on compliance, claims processing, and effective communication across departments. Proficient in utilizing Excel for data analysis and reporting to support quality audits and operational improvements.

Highest-signal resume keywords

Healthcare Insurance Quality ReviewClaims ExperienceDiagnosis Codes KnowledgeExcel ProficiencyQuality Audits

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Quality AuditsClaims ProcessingDiagnosis CodesMedical TerminologyData AnalysisExcel V-LookupsExcel Pivot TablesExcel FormulasQuality Control ProceduresWorkflow Management

Soft Skills

Problem SolvingDecision MakingCross-Functional CollaborationInfluencing ChangeCommunication

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Healthcare InsuranceQuality ChampionCompliance MonitoringService OperationsBusiness Support Tasks

About the role

Key responsibilities & impact

Act as an advocate and subject matter expert guiding the business as a quality champion
Measure and monitor the quality and effectiveness of claim processing and customer service work processes
Consult cross-functionally with other departments to influence and promote change
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
Serve as a subject matter expert on workflows, policies, systems requirements, enhancements, daily operations, and programs
Conduct standard quality reviews and audits to monitor compliance with published policies and procedures
Support targeted quality audit projects, report overall 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

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being, based on eligibility