, Connecticut

Job Description
The Quality Consultant position is responsible for auditing Case Installation work (Plan Coordination Consultants -PCC) ensuring Plan Sponsor and medical benefit information is accurate. Through the audit process the Quality Consultant provides guidance to staff ensuring knowledge and understanding for error avoidance of future work. They may engage in various projects, update prototypes, develop, recommend and participate in process improvement initiatives with a focus on quality improvement.

The primary responsibilities of the Quality Consultant include but are not limited to:
- Audit of work completed by Case Installation staff to ensure accuracy of information to interface to multiple downstream systems for eligibility and ID cards, billing, member documents, claim payment, various reporting, member portals, etc.
- Identify errors or potential errors for research or correction. Re-audit when required for any transactions where errors are found.
- Provide guidance to case installation staff through the audit process or directly when needed.
- Other responsibilities include but not limited to:
- Update of prototypes facilitating a baseline for coding of standards - Participate in various projects to represent Quality
- Continuous development and innovation of Quality process and/or Case Installation process to create efficiency and improved outputs ensuring we fulfill “Our Common Purpose: “Advocate for our members’ best health by helping them get the most from their benefits, building trust, and always providing a clear path to care.”

This position is for you if you are passionate about Case Installation and desire excellence in what this critical function does to support so many downstream internal stakeholders and those we serve every day, our Plan Sponsors and members. If you love helping others to be the best they can be through providing guidance this is your opportunity to do so. Attention to detail and a willingness to collaborate and network with others is an important part of this role. Opportunities for project participation and innovation of process improvement also provide diversity of primary responsibilities. Come and join the team and add the value of excellence.

Required Qualifications
3+ years Plan Coordination Consultant and/or Claim Data Specialist experience with successful or better results.
1+ year(s) of experience in mentoring Plan Coordination Consultant or Claim Data Specialist where the mentee experienced successful or better results.
Prior experience in an audit environment that reflects a proven track record or proficiency.
Detailed knowledge of Aetna medical benefits for other candidates not in the PCC or CDS role.

COVID Requirements
CVS Health requires its Colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, or religious belief that prevents them from being vaccinated.

If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

If you are unable to be fully vaccinated due to disability, medical condition, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
3 - 5+ years Plan Coordination Consultant and/or Claim Data Specialist experience with successful or better results.
2 - 3+ years of experience in mentoring Plan Coordination Consultant or Claim Data Specialist where the mentee experienced successful or better results.
Prior experience in an audit environment that reflects a proven track record or proficiency.
Detailed knowledge of Aetna medical benefits for other candidates not in the PCC or CDS role.

Education
Bachelor's degree or equivalent experience

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. See Job Description

, Connecticut

Continue serving and work with a purpose

As a CVS Health colleague, you'll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone's life, including your own. Learn more about how you can continue serving on your next mission at CVS Health.

Careers for Veterans and Military Spouses

 

"The military has an ethos that is grounded in purpose-driven service that’s bigger than the individual. The same holds true for us at CVS Health. You can talk to colleagues in any part of our business and they will be able to articulate our company’s purpose. Working here provides an opportunity for service members and military spouses to continue to serve, just in a civvies."

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