Description

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 Enterprise Quality assurance program and fiduciary control for Aetna. 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 an exciting and fast paced high performance organization. We are Aetna's Enterprise Level Quality Assurance Program focusing on quality improvement, trending and training opportunities.

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.

We are looking for a flexible customer focused individual who enjoys working in a team environment and can create value by anticipating and exceeding customer expectations.

The ideal candidate will have exceptional analytical, organizational and problem solving skills effective verbal and written communication skills, the ability to adapt quickly and willingly to change, and a positive attitude.

Successful candidates should be fully trained in Medicare or Medicaid High Dollar claim processing and comfortable with quality and production goals.

Required Qualifications

• 1 plus year(s) Medicare or Medicaid High Dollar Claim Processing and/ or Medicare or Medicaid High Dollar Claim Auditing Experience

Preferred Qualifications

• Knowledge of Medicare and Medicaid e.polices.
• High proficiency in processing Medicare or Medicaid High Dollar claims.
• Associate's degree of above preferred.

Education

High School Diploma or equivalent G.E.D.

We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week.

Aetna Service Operations office/hub locations will be discussed with the selected candidate

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$21.10 - $49.08

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.

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 06/30/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.