Claim Audit Quality Specialist

Position Summary

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

About the role

The Claim Audit Quality Specialist is responsible for ensuring the accuracy and quality of claim audits across multiple areas within Meritain. This role demands a deep understanding of claims, plan documents, eligibility, coverages, and the unique requirements of various groups. The analyst will become a subject matter expert, applying detailed review skills and maintaining high standards in a fast-paced, high-production environment.

Responsibilities

• Cover thorough audits of claims, ensuring compliance with plan documents and eligibility requirements
• Analyze and interpret a variety of group-specific guidelines and coverage “quirks”
• Maintain high accuracy and quality standards while meeting production goals
• Manage time effectively to balance multiple priorities in a deadline-driven setting
• Collaborate with team members to share knowledge and resolve complex audit issues
• Document audit findings clearly and provide actionable feedback

Requirements

• 1+ years of auditing and/or claims processing experience
• 1+ years of Microsoft Office experience
• Knowledge of CPT codes
• Knowledge of ICD-10 codes

Preferred Qualifications

• 1+ years of DG experience
• 2+ years of claims processing/auditing experience
• Exceptional attention to detail
• Ability to quickly become a subject matter expert in new areas
• Prowed track record of managing workload efficiently in a high-volume environment
• Self Funded claim knowledge a plus

Qualifications

• High School or GED

Pay Range

The Typical Pay Range For This Role Is $17.00 - $31.30 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.

Benefits

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.