Quality Specialist
: Job Details :

Bring 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.

Position Summary

* The Eligibility Audit process reviews work of Eligibility and COBRA Specialists to validate they are entering transactions correctly into the processing system (DG). This includes eligibility transactions sent by paper, electronic files, and entered by the client via the web.

* Transaction accuracy is evaluated using internal procedures, plan documents, industry standards, and government compliance documentation. Errors and results are communicated to the Eligibility Specialist and Supervisor. Monthly error analysis reports are created and shared with Eligibility management to evaluate individual and Eligibility team performance.

* Producing accurate and complete audit results with an understanding and concern for the steps and tasks involved in the process being audited is required.

* Following stated internal procedures, conduct research, obtain clarification of information, to ensure that all decisions made take into account the expected outcome and the effect decisions and actions have on other processes.

* Create and maintain appropriate documentation to provide timely feedback of audit results and identification of trends.

* Identify, document, and report compliance issues with respect to industry standards, state and federal guidelines.

* Teamwork is an essential component of this position due to the need for collaboration with other departments to resolve issues and deliver optimal results for our clients.

Required Qualifications

* At least 1 year in a production-based environment

Preferred Qualifications

* Prior auditing experience a plus

* Knowledge of the DG, WEX, and other Meritain processing systems preferred

* Basic knowledge of Excel

* Attention to detail

* Effective and professional written and verbal communication skills

* Strong investigative skills

* Ability to interpret Plan Document language

* Ability to multi-task and set appropriate priorities

* Ability to work independently with little guidance

Education

* High School diploma or GED

Pay Range

The typical pay range for this role is:

$17.00 - $28.46

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ( PTO ) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 11/15/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.