Senior Quality Specialist

CVS Health; Salem (OR); On-site; USD 80,000 - 100,000; Full time

Job summary

A leading health services company in Salem, Oregon is seeking a Quality Specialist to advocate for quality assurance in claim processing. The role involves conducting quality audits, consulting with departments, and ensuring compliance with standards. Candidates should have experience in health insurance and proficiency in Excel. This position offers full-time hours and a competitive pay range.

Benefits

Affordable medical plan options

401(k) with company matching

Employee stock purchase plan

Wellness programs and counseling

Qualifications

• 2+ years of health insurance work experience and/or Healthcare Insurance Quality Review.
• Moderate to advanced knowledge of Excel (V-lookups, pivot tables, and/or formulas).

Responsibilities

• Acts as a subject matter expert guiding the business.
• Performs regular quality audits for service operations.
• Consults with other departments to promote quality.

Skills

Health insurance work experience

Knowledge of diagnosis codes

Excel proficiency

Education

High School Diploma or equivalent GED

Job description

Position Summary

Acts as an advocate and subject matter expert guiding the business by serving as a quality champion through measuring and monitoring the quality and effectiveness of work processes in claim processing and customer service that impact customer satisfaction, medical cost management, and operational efficiency.

Consults cross-functionally with other departments to influence and promote change, to continually deliver quality service to both internal and external customers.

Performs regular quality audits for service operations for multiple products and platforms to drive full and consistent compliance to all required standards.

Additional Responsibilities to include but not limited to the following:

• Executes both routine and non-routine business support tasks for the Sr Quality Specialist area under limited supervision, referring deviations from standard practices to managers.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Acts as a subject matter expert on Quality Specialist workflows, policies, systems requirements, and enhancements as well as daily operations and programs to consistently drive optimal results.
• Conducts standard quality reviews and audits to proactively measure and monitor team compliance with published policies, and procedures, to effectively meet customer and regulatory guidelines.
• Owns responsibility for supporting targeted quality audit projects, reporting overall results, and making recommendations regarding training needs, quality controls, and procedures to senior management.
• Takes direction to execute techniques, processes, and responsibilities.

Required Qualifications

• 2+ years of health insurance work experience and/or Healthcare Insurance Quality Review
• 2+ years of experience working with diagnosis codes and medical terminology.
• Moderate to advanced knowledge of Excel (V-lookups, pivot tables, and/or formulas)

Preferred Qualifications

• Working knowledge of problem solving and decision making skills
• College degree preferred
• Claims experience
• DG experience

Education

• High School Diploma or equivalent GED

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $42.35

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information about benefits, visit our benefits page.

We anticipate the application window for this opening will close on: 09/19/2025

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.