质量审查与审计高级分析师，个人牙科运营 - Cigna Health

Position Summary
The Quality Review and Audit Senior Analyst conducts quality reviews and audits of internal operations and vendor-supported activities within Individual Dental Operations. This role evaluates compliance with established procedures, quality standards, business requirements, and applicable regulatory expectations.
The Senior Analyst independently manages routine and complex audit assignments, documents and communicates findings, analyzes quality results, and identifies trends, process gaps, and improvement opportunities. The role serves as an experienced technical resource for Quality Review and Audit team members and supports calibration, reporting, onboarding, and process-improvement activities.
This position works closely with Operations, Compliance, vendor partners, and other business teams to promote consistent execution, strengthen operational quality, and improve customer outcomes.
Core Accountabilities and Responsibilities
Quality Review and Audit Execution

• Conduct quality reviews and audits of customer interactions, operational transactions, and supporting system activity.

• Evaluate work against established procedures, quality standards, scoring guidelines, business requirements, and applicable regulatory expectations.

• Independently manage assigned audits from case selection and evidence review through scoring, documentation, and completion.

• Perform routine and complex reviews involving internal operations and vendor-supported processes.

• Maintain accurate and complete audit records that support audit scores, findings, and conclusions.

• Identify cases requiring additional review, calibration, or subject matter expertise.

• Monitor assigned work to ensure audit requirements and established completion expectations are met.

• Support internal, vendor, regulatory, or third-party audit activities by gathering documentation, reviewing selected cases, responding to questions, and validating relevant information.

Findings and Quality Analysis

• Analyze audit results to identify recurring errors, quality trends, process gaps, and potential operational risks.

• Distinguish isolated errors from patterns that may require broader business review or corrective action.

• Provide clear examples and supporting evidence when communicating identified trends or concerns.

• Prepare summaries and initial analyses of audit results for review by Quality Assurance leadership.

• Assist with the development and distribution of recurring quality and audit reporting.

• Compare audit findings across employees, processes, vendors, or review periods when appropriate data is available.

• Escalate significant quality, compliance, system, or process concerns to the Lead Analyst or Quality Assurance leadership.

• Recommend areas for additional monitoring, calibration, training, or process review based on audit evidence.

Calibration and Audit Consistency

• Participate in internal and vendor calibration sessions to support consistent interpretation of audit standards and scoring guidelines.

• Independently identify appropriate cases for calibration when questions or potential inconsistencies arise.

• Serve as backup to the Lead Analyst for internal calibration activities.

• Explain scoring decisions and provide supporting evidence during calibration discussions.

• Help identify unclear audit criteria, scoring guidance, or procedural requirements requiring clarification.

• Apply calibration decisions consistently to subsequent audit work.

• Share calibration outcomes and relevant guidance with team members as directed.

Technical and Team Support

• Serve as an experienced resource for Quality Review and Audit team members by answering technical questions and providing guidance on established procedures.

• Support less-experienced team members with audit methodology, system navigation, documentation, and scoring questions.

• Assist with onboarding and job-shadowing activities for new Quality Review and Audit employees.

• Help reinforce consistent audit practices through knowledge sharing and peer support.

• Refer complex, unresolved, or precedent-setting questions to the Lead Analyst or appropriate business owner.

• Provide objective, constructive feedback supported by audit evidence and established standards.

• Perform Lead Analyst backup activities when assigned and within the individual’s demonstrated knowledge and authority.

Process and Quality Improvement

• Identify and communicate gaps in procedures, workflows, systems, training, or audit guidance.

• Assist with quality-improvement projects and the evaluation of new or revised procedures.

• Provide audit observations and supporting data to business partners responsible for corrective or preventive actions.

• Participate in testing or validation activities associated with process, system, or procedural changes.

• Help evaluate whether implemented changes address previously identified quality issues.

• Recommend practical enhancements to audit guidelines, job aids, procedures, controls, or training based on recurring findings.

• Support updates to audit documentation when business or regulatory requirements change.

Cross-Functional Partnership

• Work with Operations, Compliance, vendor partners, and other matrix teams to research findings and address quality concerns.

• Present audit results and supporting information clearly and professionally to business and vendor partners.

• Build productive working relationships while maintaining objectivity and consistency in audit decisions.

• Communicate system issues and operational barriers promptly to the appropriate lead or supervisor.

• Support technical troubleshooting and incident-escalation activities when system issues affect audit completion or accuracy.

• Promote partner and customer satisfaction through accurate reviews, timely communication, and constructive problem-solving.

Qualifications
Required

• 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.

Preferred

• Experience supporting Individual Dental, Individual and Family Plans, or another regulated healthcare operation.

• Knowledge of federal and state regulatory requirements applicable to the supported business.

• Experience with call monitoring, transaction auditing, claims review, or operational system reviews.

• Experience analyzing quality trends or preparing audit summaries and reports.

• Experience participating in calibration sessions or supporting audit-scoring consistency.

• Experience assisting with onboarding, peer coaching, or technical training.

• Experience supporting corrective actions, quality projects, or process-improvement initiatives.

• Experience with OnBase, Microsoft Access, or comparable audit and reporting tools.

• Ability to travel occasionally based on business needs.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 58,400 - 97,400 USD / yearly, depending on relevant factors, including experience and geographic location.This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you need a reasonable accommodation to complete the online application process, please email for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Originally posted on Himalayas