Quality Consultant – CSO/PSS

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.

The Quality Consultant position is responsible for auditing Large Group PSS Functions (Implementation, Case Installation, Claims).

The primary responsibilities of the Quality Consultant include but are not limited to:

– Audit of work completed by Implementation, Case Installation, Claims staff to ensure accuracy of information.

– Identify errors or potential errors for research or correction.

– Re-audit when required for any transactions where errors are found.

– Provide guidance to case installation staff through the audit process or directly when needed.

Other responsibilities include but not limited to:

– Update of prototypes facilitating a baseline for coding of standards

– Participate in various projects to represent Quality

– Continuous development and innovation of Quality process and/or Case Installation process to create efficiency and improved outputs ensuring we fulfill Our Common Purpose: Advocate for our members best health by helping them get the most from their benefits, building trust, and always providing a clear path to care.

This position is for you if you are passionate about excellence to support so many downstream internal stakeholders and those we serve every day, our Plan Sponsors and Members. Attention to detail and a willingness to collaborate is an important part of this role. Opportunities for project participation and innovation of process improvement also provide diversity of primary responsibilities. Come and join the team and add the value of excellence.

– Strong problem solving and critical thinking skills

– Strong analytical skills

– Excellent verbal and written communication skills

– Ability to manage multiple priorities

– Strong attention to detail and accuracy

– Strong organization skills.

– Ability to work independently in a team environment

– Strong team player/collaborator

Required Qualifications

– 3-5 years Commercial Medical and Pharmacy benefits product knowledge.

– Prior experience in an audit environment that reflects a proven track record or proficiency in the competencies noted.

– Experience with Aetna applications: QuickBase, and basic MS Office Excel and Word.

Preferred Qualifications

– ACAS system experience (viewing or processing)

Education

– Bachelors degree or equivalent commercial healthcare insurance experience.

Pay Range

The typical pay range for this role is:

$18.50 – $38.82

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 (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 10/04/2024

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

We are an equal opportunity and affirmative action employer. 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.