CVS Health is dedicated to building a connected and compassionate health experience. They are seeking a Quality Audit Control Analyst to perform quality audits for service operations, focusing on Medicare and Medicaid claims processing and ensuring compliance with performance metrics and internal controls.

Responsibilities

• Performs quality audits for service operations for multiple products and platforms and is the official source for Customer/Plan Sponsor performance guarantee reporting, SOX and SOC1, Internal Audit/Compliance controls and the official source for Service Level Agreements (SLA for Vendor) and Book of Business reporting
• Government Programs Claim Quality is the official source for all customer performance guarantee and key performance metric reporting
• We are the SOX and Sarbanes control for Medicare and Medicaid Claim Processing
• Looking for a flexible customer focused individual who enjoys working in a team environment and can create value by anticipating and exceeding customer expectations

Skills

• 1 plus year(s) Medicare or Medicaid High Dollar Claim Processing and/ or Medicare or Medicaid High Dollar Claim Auditing Experience
• Knowledge of Medicare and Medicaid e.policies
• High proficiency in processing Medicare or Medicaid High Dollar claims
• Associate's degree of above preferred

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility

Company Overview

Company H1B Sponsorship