Quality Auditor Senior Manager

Position Summary

The Senior Manager, Quality Assurance and Audit is a critical leadership role responsible for the strategic oversight and execution of quality programs within the Grievance & Appeals QA organization. This role ensures operational excellence, regulatory compliance, and audit readiness across Medicare, Medicaid, and Duals lines of business. The Senior Manager leads and develops a high-performing team of Quality Analysts and serves as a subject matter expert for G&A quality standards, policies, and audit processes. This leader partners cross-functionally to drive continuous improvement, mitigate compliance risk, and deliver best-in-class quality outcomes in a highly regulated environment.

Key Responsibilities

• Design, implement, and continuously improve internal QA processes to deliver best-in-class audit performance and compliance outcomes

• Lead oversight of case and letter quality reviews, ensuring accuracy, timeliness, and adherence to regulatory requirements

• Conduct regular quality audits and case reviews; identify trends, risks, and improvement opportunities

• Audit Leadership & Regulatory Readiness

  • Lead internal and external audit preparation, presentations, and responses, including state and federal regulatory audits

  • Serve as a primary quality and compliance liaison during external reviews and examinations

  • Provide expert input for policy updates, system enhancements, and regulatory interpretation

• People Leadership & Performance Management

  • Lead, mentor, and develop a team of Quality Analysts in a remote environment

  • Track, monitor, and manage staff quality performance, providing ongoing feedback, coaching, and corrective action plans as needed

  • Ensure completion of required training, continuing education, and skill development for QA staff

• Operational Excellence

  • Perform daily monitoring of inventory to support timeliness standards and workload balancing

  • Collaborate on the development and maintenance of QA desktops, job aids, and training materials

  • Partner with operational, compliance, and leadership teams to support enterprise quality goals

Required Qualifications

• 7+ years of experience of quality or audit responsibility in Medicare, Medicaid, and/or Duals Grievance & Appeals, with demonstrated QA or oversight responsibility

• Proven experience leading external regulatory audits and formal quality reviews

• Deep knowledge of integrated G&A regulatory requirements

• Experience leading and developing remote teams

• Strong training, mentoring, and coaching experience (virtual and/or in-person)

• Advanced communication, analytical, and supervision skills

Preferred Qualifications

• Experience with state and federal regulatory requirements

• Strong deductive reasoning and advanced analytical skills

• Proficiency with Microsoft Office Suite and Quickbase

• Demonstrated problem-solving ability in complex, regulated environments

• Collaborative, team-oriented leadership style

Pay Range

The Typical Pay Range For This Role Is $67,900.00 - $182,549.00 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. This position also includes an award target in the company’s equity award program.