CVS Health

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Senior Quality Consultant

at CVS Health

Posted: 7/29/2020
Job Reference #: 71906BR

Job Description

Job Description
Accountable for review and/or handling of quality complex audits for benefit administration company.In this role the successful candidate will primarily focus on auditing of health plan documents, including summary plan descriptions (SPD), plan amendments and Summary of Benefits and Coverage (SBC) for self-funded plans to measure compliance with published policies, procedures, customer and regulatory guidelines.

Fundamental Components
  • Develop and implement quality assessment/audit/measurement programs tailored to plan document drafting team.
  • Create strategies to educate and address continuous quality improvement opportunities.
  • Identify and establish internal and external benchmarks for performance evaluation to include standards, procedures and corrective actions to be followed.
  • Influence changes/enhancements to business processes, policies, and system infrastructure to improve quality of documents being produced by the plan document drafting team.
  • Develop and design data collection capability (e.g., customer surveys focus groups, system reports) and develop appropriate measures.
  • Analyze customer feedback and other measures of quality.
  • Analyze data for trends, highlights in-depth interpretations and provides in-depth root cause analysis of findings.
  • Provide regular employee coaching and mentoring based on analyzed data.
  • Creates and updates training documentation such as training outlines, manuals, job aids and other materials.
  • Coordinate, schedule and facilitate the development of training for new and existing team members.
  • May deliver advanced training and may provide guidance or expertise to plan document drafting team.

Background Experience
  • 3 - 5 years Experience in an audit/quality review environment.
  • Experience with Third Party Administration and Self-Funding supporting custom health insurance products and/or services.
  • Demonstrates critical thinking and analytical ability.
  • Demonstrates ability to train others by sharing knowledge.
  • Effective time management, organizational and prioritization skills.
  • Regarded as approachable.
  • Demonstrates aptitude to develop people and processes.
  • Plan drafting experience supporting self-funded or fully insured plans.
  • Strong attention to detail and accuracy performing at high levels in a fast paced and constantly changing work environment.
  • Ability to give and receive constructive feedback.

Bachelor's degree or equivalent experience

Percent of Travel Required
0 - 10%

Business Overview
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.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!