Senior Quality Review and Audit Analyst, Individual Dental Operations

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $58.4k - $97.4k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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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 and audits of customer interactions, operational transactions, and supporting system activity • Evaluate work against procedures, quality standards, scoring guidelines, business requirements, and regulatory expectations • Manage routine and complex audits from case selection and evidence review through scoring, documentation, and completion • Maintain audit records supporting scores, findings, and conclusions • Support internal, vendor, regulatory, or third-party audit activities • Analyze audit results to identify recurring errors, quality trends, process gaps, and operational risks • Prepare audit summaries and initial analyses for Quality Assurance leadership • Assist with recurring quality and audit reporting • Participate in internal and vendor calibration sessions • Serve as a technical resource for team members and support onboarding and job-shadowing • Identify gaps in procedures, workflows, systems, training, and audit guidance • Assist with quality-improvement projects, process changes, testing, and validation • Work with Operations, Compliance, vendor partners, and matrix teams to research findings and address quality concerns • Present audit results and supporting information to business and vendor partners • Support technical troubleshooting and incident escalation when system issues affect audit completion or accuracy

🎯 Requirements

• Three or more years of relevant experience in healthcare operations, customer service, benefits, eligibility, claims, contact center operations, quality assurance, or auditing • Previous experience conducting quality reviews, operational audits, transaction reviews, or comparable control activities • Demonstrated ability to independently complete routine and complex audit assignments • Experience applying audit criteria, scoring guidelines, procedures, and business requirements consistently • Ability to identify trends and communicate findings using clear examples and supporting evidence • Strong analytical, problem-solving, and decision-making skills • Strong attention to detail and commitment to accurate audit documentation • Ability to manage multiple assignments and priorities in a fast-paced environment • Strong written and verbal communication skills • Ability to provide technical support and guidance without formal supervisory authority • Proficiency with Microsoft Office applications, particularly Microsoft Excel • Ability to work collaboratively with internal teams, business partners, and vendor organizations • If working at home occasionally or permanently, cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload is required

🏖️ Benefits

• Annual bonus plan eligibility • Medical benefits • Vision benefits • Dental benefits • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence