Quality Review and Audit Analyst, Individual Dental Operations

Job not on LinkedIn

🔥 12 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Conduct quality reviews through call monitoring, transaction review, claim review, or examination of operational systems and records • Evaluate work against procedures, audit guidelines, quality standards, business requirements, and regulatory expectations • Apply scoring criteria and quality controls consistently • Complete routine and moderately complex audits within productivity, accuracy, and timeliness expectations • Record audit results and maintain supporting documentation • Identify and document errors, procedural gaps, recurring observations, and potential trends • Escalate unusual circumstances, compliance concerns, customer-impacting issues, and technical barriers • Enter, validate, organize, and summarize audit data using designated systems, trackers, reporting tools, Microsoft Excel, and other approved tools • Assist with standard audit reports, summaries, report distribution, questionnaires, case validation, error responses, and evidence collection • Participate in calibration sessions, training, coaching, job shadowing, and knowledge-sharing activities • Maintain current knowledge of procedures, audit guidance, products, systems, and business requirements • Identify process, procedure, audit-guidance, and documentation gaps • Assist with quality and process-improvement initiatives, testing, and validation activities • Build relationships with Quality Assurance colleagues and matrix partners • Support onboarding through job shadowing or process demonstration when assigned

🎯 Requirements

• Relevant experience in healthcare operations, customer service, benefits, eligibility, claims, contact center operations, quality assurance, auditing, or a comparable business environment • Ability to follow detailed audit procedures, scoring guidelines, and quality standards • Strong attention to detail and commitment to accurate documentation and data entry • Ability to identify errors and communicate findings clearly and professionally • Basic analytical and problem-solving skills • Ability to manage assigned work and meet established deadlines • Strong written and verbal communication skills • Ability to work effectively in a team and matrixed business environment • Proficiency with Microsoft Office applications • Ability to learn and use systems required to perform assigned audit work • Flexibility to adjust to changing procedures, workload, and business needs • Previous experience conducting audits, quality reviews, call monitoring, transaction reviews, or claims reviews • Experience in Individual Dental, Individual and Family Plans, or another healthcare or insurance operation • Familiarity with regulated operating environments and compliance requirements • Experience entering, validating, or summarizing audit and quality data • Experience using Microsoft Excel or comparable tools to organize information and identify basic trends • Knowledge of customer service, benefits, eligibility, claims, or contact center operations • Ability to travel occasionally based on business needs

🏖️ Benefits

• Remote work option, subject to required cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload • Tobacco-free policy • Reasonable accommodation support for the online application process