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Job Title :
Supervisor - Quality Assurance Medicaid and Exchanges
Job ID :
Location :
AZ - Scottsdale
Street Address :
9501 E Shea Blvd
Category :
Description :
Job Description
The Quality Assurance Supervisor is responsible for leading a team of consultants and Senior consultants who perform quality monitoring for Medicaid and Exchange claims processing within the PBM operations. The Supervisor will lead, mentor and develop a diverse team of individuals who are responsible for ensuring Medicaid/Exchange claims are processed appropriately and within state and client guidance. The Quality Assurance department oversees plan practices, standards, methodologies and metrics to improve business performance, to validate compliance with government regulations and to improve operational performance. This position is focused on raising the level of quality within the PBM operations and to improve the Medicaid/Exchange beneficiary experience with the plan. The Quality Assurance Supervisor will manage multiple tasks and priorities and guide the MQA team members in their daily tasks. Those tasks include performing root cause analysis, reporting findings, collaborating with operational leaders and creating innovative and automative tools to influence quality improvements. The Supervisor will be responsible for fielding requests from other operations, developing project plans and allocating resources to these activities. The position requires flexibility and the willingness/ability to build new processes as required.

Required Qualifications
-1+ years management of mid-size staff (8-15 employees)
-2+ years extensive knowledge of Microsoft word, excel, Visio, and Powerpoint
-1+ year of PBM and RxClaim subject knowledge

Preferred Qualifications
-Proven analytical skills and attention to detail
-Ability to effectively define issues, collect data, establish facts, and draw valid conclusions
-Knowledgeable of claim adjudication, benefit plan design, Medicaid and RxClaim adjudication
-Ability to interpret and integrate state Medicaid guidance into applicable processes
-Proficient in analyzing specific types of moderate to complex claim transactions and proven experience in delivering accurate and precise results
-Excellent verbal and written communication, demonstrated ability to document and present concepts in a clear, concise and logical manner
-Ability to meet deadlines with a variety of responsibilities
-Ability to creatively solve problems when dealing with a variety of variables in situations where standard resolutions do not exist
-Independent and innovative startup mindset
-Strong presentation, communication and reporting skills

High School Diploma or GED required
Bachelor’s Degree preferred

Business Overview
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website:

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CVS Health core values of Innovation, Collaboration, Caring, Integrity, and Accountability not only support our purpose of helping people on their path to better health for our customers and patients, but they also apply to how we support our more than 250,000 colleagues. You will find our culture at CVS Health, and our leaders encourage personal and professional growth.

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