Provider Network Audit Quality Analyst
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Idaho • New York • United States
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Salary
💰 $19 - $42 per hour
Job Level
About the role
- Conduct standard quality reviews and audits to ensure compliance with internal policies, procedures, and regulatory guidelines
- Identify, document, and communicate errors to business partners for resolution
- Support daily operations and maintenance of assigned functional units
- Analyze audit data to identify trends and recommend process improvements
- Participate in special projects and targeted quality audit initiatives
- Provide subject matter expertise on workflows, systems, and operational procedures
- Collaborate with business owners to support the design and implementation of new processes
- Develop and implement quality programs and contribute to test plan development
- Analyze and resolve complex claims scenarios within established timeframes
- Respond to internal and external customer inquiries and complaints
- Monitor and reconcile system activity to ensure data integrity and financial accuracy
Requirements
- 1–2+ years of experience in a quality audit or claims testing environment
- Working knowledge of PPO networks and healthcare claims processing
- Strong analytical and problem-solving skills
- Proficiency in using systems and tools for data analysis and auditing
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- Wellness screenings
- Tobacco cessation programs
- Weight management programs
- Confidential counseling
- Financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
- Many other benefits depending on eligibility
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
quality reviewsauditsdata analysisclaims processingprocess improvementsquality programstest plan developmentdata integrityfinancial accuracy
Soft Skills
analytical skillsproblem-solving skillscommunication skillscollaboration