Quality Review and Audit Lead Analyst, Individual Dental Operations

🔥 20 minutes ago

🐊 Florida, Missouri, +2 more states – Remote

🐊 Florida – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – 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

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 and coordinate quality reviews and audits of internal operations and vendor-supported processes • Support audit 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 among audit professionals, operational teams, and vendor partners • Collect, validate, analyze, and summarize audit and quality data • Develop and maintain reports, dashboards, and analyses on quality performance, findings, trends, and improvement opportunities • Identify patterns, recurring findings, emerging risks, and reporting gaps • Communicate analytical findings to Quality Assurance, Operations, vendors, and business partners • Define data-collection requirements and address reporting gaps • Develop tracking and reporting capabilities supporting operating-model changes and business growth • Analyze root causes, business and customer impacts, and compliance risks of audit findings • Support corrective and preventive actions, remediation tracking, and unresolved-risk reporting • Present audit results and analysis to internal stakeholders and vendor partners • Support regulatory changes through updates to audit tracking, workflows, job aids, procedures, and policies • Identify process-improvement opportunities using audit results and operational observations • Lead or support enhancements to audit procedures, reporting, workflows, quality controls, and customer-facing processes • Partner with Operations, Compliance, vendors, and business 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 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

🎯 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 presenting 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 or more 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 • If working at home, cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload is required

🏖️ Benefits

• Remote work arrangement • Ability to travel occasionally based on business needs • Equal employment opportunity protections • Reasonable accommodation support for the online application process • Tobacco-free policy • Consideration of qualified applicants with criminal histories consistent with applicable laws