Quality Review and Audit Analyst, Individual Dental Operations

🔥 0 minutes ago

🐊 Florida, Missouri, +2 more states – Remote

🐊 Florida – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – 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

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 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 in designated systems, trackers, and reporting tools • Maintain documentation supporting audit scores, errors, and review outcomes • Identify and document errors, procedural gaps, and unmet quality requirements • Communicate audit findings with clear examples and supporting facts • Recognize recurring observations and share potential trends • Escalate unusual, compliance, customer-impacting, or technically complex concerns • Enter, validate, and organize audit data for quality reporting • Assist with standard audit reports, summaries, report distribution, questionnaires, case validation, error responses, and evidence collection • Use Microsoft Excel and approved tools for basic trend identification • Participate in calibration sessions and incorporate feedback into audit work • Maintain knowledge of procedures, products, systems, and business requirements • Participate in training, coaching, job shadowing, and knowledge-sharing activities • Identify process, procedure, audit-guidance, and documentation gaps • Assist with quality and process-improvement initiatives, testing, and validation • Build relationships with Quality Assurance colleagues and matrix partners • Support onboarding through job shadowing or process demonstration

🎯 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 (preferred) • Experience in Individual Dental, Individual and Family Plans, or another healthcare or insurance operation (preferred) • Familiarity with regulated operating environments and compliance requirements (preferred) • Experience entering, validating, or summarizing audit and quality data (preferred) • Experience using Microsoft Excel or comparable tools to organize information and identify basic trends (preferred) • Knowledge of customer service, benefits, eligibility, claims, or contact center operations (preferred) • Ability to travel occasionally based on business needs (preferred) • 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 arrangement • Cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload for home working • Equal employment opportunity protections • Reasonable accommodation for the online application process • Tobacco-free policy and access to a qualifying smoking cessation program where applicable