Quality Review and Audit Lead Analyst, Individual Dental Operations

Job not on LinkedIn

🔥 0 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟠 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 and coordinate quality reviews and audits of internal operations and vendor-supported processes • Support review planning, case selection, evidence collection, documentation, analysis, and reporting • Evaluate complex audit findings and engage business owners or subject matter experts when needed • Maintain accurate audit documentation supporting findings, conclusions, and recommended actions • Monitor audit activities and deliverables against regulatory turnaround requirements and internal expectations • Collect and organize evidence for enterprise, regulatory, internal, or external audits • Identify compliance concerns and escalate material findings or risks • Support calibration activities among audit professionals, operational teams, and vendor partners • Collect, validate, analyze, and summarize audit and quality data • Develop and maintain reports, dashboards, and analyses covering quality performance, findings, trends, and improvement opportunities • Identify patterns, recurring findings, emerging risks, and reporting gaps • Communicate analytical findings to Quality Assurance, Operations, vendor, and business partners • Define data-collection requirements and develop tracking and reporting capabilities • Analyze findings for root causes, business impacts, customer impacts, and compliance risks • Support corrective and preventive actions, remediation tracking, and unresolved-risk reporting • Present audit results and supporting analysis to stakeholders and vendor partners • Support regulatory changes by updating audit tracking, workflows, job aids, procedures, and policies • Identify process-improvement opportunities and lead or support improvement project components • Partner with Operations, Compliance, vendors, and other teams to develop sustainable solutions • Evaluate whether implemented changes address findings and improve quality • Recommend updates to controls, documentation, training, reporting, and monitoring • Develop, maintain, and update audit procedures, SOPs, job aids, workflows, and supporting documentation • Provide technical direction and quality-related guidance to audit professionals and team members • Serve as a resource for audit methodology, data interpretation, documentation, and complex findings • Manage multiple assignments and priorities independently while adapting to changing business needs

🎯 Requirements

• Three or more years of relevant experience in healthcare operations, benefits, eligibility, claims, customer service, contact center operations, sales, quality assurance, or auditing • Experience conducting quality reviews, audits, operational analyses, or comparable control activities • Strong analytical, conceptual-thinking, and problem-solving skills • Ability to collect, validate, analyze, and interpret quality or operational data • Ability to identify patterns, evaluate complex findings, and communicate practical recommendations • Strong attention to detail and ability to maintain accurate, supportable audit documentation • Ability to manage multiple responsibilities and complete time-sensitive work in a fast-paced environment • Strong written and verbal communication skills, including ability to present findings to business and vendor partners • Ability to work independently, exercise sound judgment, and adjust priorities based on business needs • Strong collaboration skills and ability to work effectively within a matrixed organization • Proficiency with Microsoft Office applications, particularly Microsoft Excel • Ability to provide technical guidance and support to colleagues without formal supervisory authority • Preferred: three+ years of related experience in a healthcare or insurance environment • Preferred: experience supporting Individual Dental, Individual and Family Plans, or another regulated health-benefits operation • Preferred: knowledge of applicable federal and state regulatory requirements affecting individual insurance operations • Preferred: understanding of Affordable Care Act and federal exchange requirements where relevant • Preferred: experience with internal, external, regulatory, or vendor quality audits • Preferred: experience developing quality reporting, data-collection processes, audit analytics, or performance-tracking tools • Preferred: experience supporting corrective actions, process improvements, or quality-improvement projects • Preferred: experience with OnBase, Microsoft Access, Minitab, or comparable data and reporting tools • Preferred: ability to travel occasionally based on business needs • If working at home, internet connection must be through a cable broadband or fiber optic provider with speeds of at least 10Mbps download/5Mbps upload

🏖️ Benefits

• Remote work/home working permitted, subject to cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload • Occasional travel based on business needs • Equal employment opportunity protections • Reasonable accommodation support for the online application process • Tobacco-free policy