Senior Quality Specialist

Job DescriptionSenior Quality Specialists are the faces of Aetna and impacts members' service experience by manner of how customer service inquiries and problems via telephone, internet or written correspondence are handled. Calls are typically non-routine and may require deviation from standard screens, scripts, and procedures to engage, consult and educate members based upon the member's unique needs, preferences and understanding of Aetna plans, tools, and resources to help guide the members along a clear path to care. Act as subject matter expert by providing training, coaching, or responding to complex issues. Will be responsible to analyze and resolve issues associated with agent commissions. Answers questions and resolves issues as a "single-point-of-contact" based on phone calls, letters, and internet from brokers, marketing plan sponsors, PSS/ISO, members, and providers. Activities may include providing Commission status information, benefit coverage interpretations, and explaining Commission transactions. Creates an emotional connection with our agents by understanding and engaging with agents. Taking accountability to fully understand the agent's needs by building a trusting and caring relationship with the agent. Anticipates agent's needs. Provides the agent with related information to answer the unasked questions, e.g. additional details, benefit plan details, agent self-service tools, etc. Uses customer service threshold framework to make financial decisions to resolve agent issues. Processes commission transactions and addresses agent complaints. Escalates issues as appropriate through the target system for grievances and appeals. Initiates out-reach/welcome calls to ensure constituents expectations are met or exceeded. Through in-depth analysis, identifies complaint trends and any emerging agent service issues and works to develop solutions to address potential problems. Educates agent on various elements of information and available services created to enhance the overall customer service experience with the company (i.e., assistance with agent self-service tools). Partners with other departments to deliver client specific presentations. Coordinate's efforts both internally and across departments to successfully resolve service issues and develop process improvements intended to enhance the overall delivery of service. Serves as SME providing technical assistance when needed on call related issues, products, and/or system applications delivery matters. Coaches, trains and assists in the development of call center staff. May participate and/or lead special projects/initiatives addressing service issues. May provide technical or subject matter expertise concerning policies, procedures, and function-related applications/systems tools. Delivers internal quality reviews. Provides appropriate support in third party audits when required. Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes.Pay RangeThe typical pay range for this role is:Minimum: 18.50Maximum: 33.65Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications1-2 years Must Have MS Excel (Pivot Tables, V look Ups, Basic Formulas)Customer Service experiences in a transaction-based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate. 1-2 years a plus1-2 years Call Escalation resolution a plus Experience in a production or commission environment preferred.Demonstrated ability to handle multiple assignments competently, accurately and efficiently.TN candidates will work a Hybrid schedule coming into the office 1 day weekPreferred QualificationsSQL experienceEducationAssociated degree or equivalent work experience.Business OverviewBring your heart to CVS Health Every 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. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-10-04