Claim Audit Quality Specialist

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.

Position Summary

The Claim Audit Quality Specialist will audit pre- and post-payment claims for accuracy and eligibility transactions. They will also be responsible for identifying errors, necessary corrective measures, and may participate in special audit assignments.

In this role, you will:

• Work consistently out of a production queue, auditing any assigned claims.
• Oversee the completion several reviews a day, utilizing plan documents as a primary source.
• Utilize DG system to complete all reviews.
• Complete various tasks as assigned by team leads, and attend internal meetings as needed.
• Collaborate with internal account representatives and/or claims examiners as needed.

Required Qualifications

• 1+ year of experience working in a health care setting.
• At least 6 months of experience with interpreting and understanding of plan documents.
• Demonstrated knowledge of Microsoft Excel.

Preferred Qualifications

• 1-2 years of claims processing experience.
• 1-2 years of auditing experience.
• Ability to succeed in a production driven environment, managing multiple tasks while shifting priorities and maintaining a high work volume.
• Excellent verbal and written communication skills, with the ability to interact effectively and courteously.
• Ability to work with minimal guidance while delivering accurate and timely results.
• Strong time management, attention to detail, and organizational skills.
• Team-oriented personality.

Education

• High school diploma or GED.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$17.00 - $34.15

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, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 03/13/2026

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