Job Information
CVS Health Provider Network Audit Quality Analyst in Work At Home, North Dakota
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 Quality Auditor serves as a quality champion and advocate for the business by conducting routine audits and claim testing related to PPO network creation. This role supports the continuous improvement of work processes that impact customer satisfaction, medical cost management, and operational efficiency. The auditor collaborates cross-functionally to promote compliance, identify trends, and drive quality initiatives.
Key Responsibilities:
Conduct standard quality reviews and audits to ensure compliance with internal policies, procedures, and regulatory guidelines.
Identify, document, and communicate errors to business partners for resolution.
Support daily operations and maintenance of assigned functional units.
Analyze audit data to identify trends and recommend process improvements.
Participate in special projects and targeted quality audit initiatives.
Provide subject matter expertise on workflows, systems, and operational procedures.
Collaborate with business owners to support the design and implementation of new processes.
Develop and implement quality programs and contribute to test plan development.
Analyze and resolve complex claims scenarios within established timeframes.
Respond to internal and external customer inquiries and complaints.
Monitor and reconcile system activity to ensure data integrity and financial accuracy.
Required Qualifications
1–2+ years of experience in a quality audit or claims testing environment.
Working knowledge of PPO networks and healthcare claims processing.
Strong analytical and problem-solving skills.
Proficiency in using systems and tools for data analysis and auditing.
Preferred Qualifications
Experience with quality assurance programs in a healthcare or insurance setting.
Familiarity with regulatory compliance standards.
Excellent communication and collaboration skills.
Ability to manage multiple priorities and meet deadlines.
Education
- High school diploma or equivalent required.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$18.50 - $42.35
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: 03/27/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.