Senior Quality Specialist- HYBRID SCHEDULE

Job DescriptionSr Quality Specialist Claims Senior Medicare Supplement Auditor providing quality audit reviews to manual processors as well as system audit reviews regarding Medicare Supplement health claims. Communicate to impact. Team collaboration.Required QualificationsHybrid work schedule; In- office required for 2 Days a weekHealth insuranceProcessing and auditing insurance1-3 years Medicare Supplement Claims processing/ audit experience. Claims audit reviews to ensure proper claims adjudication. Review and assesses appropriateness of document changes in accordance with internal procedures as well as state regulations.Microsoft Excel Reporting Required Microsoft Office Required Contributes to reviewing claims for adequacy of rootcause, corrections, corrective actions, preventive actionsand effectiveness. Must be excellent problem solver andproactive solution seeker. Ability to work in a fast paced environment. Worked in a previous production environment. Excellent attention to detail; sound judgment; initiative and flexibility. Strong interpersonal communication and relational skills. Excellent verbal and written skills, ability to interact within all levels of organizationCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications1-5+ years Medicare Supplement Health experience in claims/ processing/ audit environment that reflects a proven track record or proficiency in the competencies noted. Basic Microsoft Outlook, Microsoft Teams experience helpful. Excel. Intermediate/Advanced proficiency in office technology.EducationHigh School Diploma G.E.D. or equivalent experienceBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-10-04