Senior Quality Review and Audit Analyst, Individual Dental Operations

🔥 30 minutes ago

🏰 Missouri, Pennsylvania, +1 more states – Remote

🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🤠 Texas – Remote

💵 $58.4k - $97.4k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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 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 assigned audits from case selection and evidence review through scoring, documentation, and completion • Maintain accurate audit records supporting scores, findings, and conclusions • Analyze audit results to identify recurring errors, quality trends, process gaps, and operational risks • Prepare audit-result summaries and initial analyses for Quality Assurance leadership • Assist with recurring quality and audit reporting • Participate in internal and vendor calibration sessions • Serve as an experienced technical resource and support less-experienced team members • Assist with onboarding and job-shadowing activities • Identify gaps in procedures, workflows, systems, training, and audit guidance • Support quality-improvement projects, corrective actions, process changes, and validation activities • Work with Operations, Compliance, vendor partners, and matrix teams to research findings and address quality concerns • Present audit results clearly to business and vendor partners • Support technical troubleshooting and incident escalation when system issues affect audit completion or accuracy • Perform Lead Analyst backup activities when assigned

🎯 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, cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload is required

🏖️ Benefits

• Annual bonus plan eligibility • Medical, vision, and dental benefits starting on day one • 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 • Remote work arrangement