质量审查与审计负责人，个人牙科运营 - Cigna Health

Position Summary
The Quality Review and Audit Lead Analyst supports the quality assurance and audit functions within Individual Dental Operations. This role conducts and coordinates internal and vendor quality reviews, analyzes audit results, develops reporting, identifies operational trends and risks, and works with business partners to improve processes, controls, and customer outcomes.
The Lead Analyst applies advanced knowledge of quality assurance, auditing, operational processes, and data analysis to complex assignments requiring independent judgment. The role supports daily audit operations, evaluates complex findings, maintains audit procedures and supporting documentation, and provides technical guidance to audit professionals and business partners.
This position also uses audit data and operational insights to identify compliance risks, reporting gaps, process deficiencies, and opportunities for continuous improvement, cost efficiency, and an enhanced customer experience.
Core Accountabilities and Responsibilities
Quality Review and Audit Execution

• Conduct quality reviews and audits of internal operations and vendor-supported processes to evaluate adherence to established requirements, procedures, and controls.

• Support daily audit activities, including review planning, case selection, evidence collection, documentation, analysis, and reporting.

• Evaluate complex audit findings independently, engaging business owners or subject matter experts when additional technical interpretation is required.

• Maintain complete and accurate audit documentation that supports findings, conclusions, and recommended actions.

• Monitor audit activities and deliverables to ensure applicable regulatory turnaround requirements and internal expectations are met.

• Support the collection and organization of evidence required for enterprise, regulatory, internal, or external audits.

• Identify potential compliance concerns and escalate material findings or risks to the appropriate business owner.

• Support calibration activities among internal audit professionals, operational teams, and vendor partners to promote consistent application of audit standards.

Quality Reporting and Analytics

• Collect, validate, analyze, and summarize audit and quality data using approved systems and analytical tools.

• Develop and maintain reports, dashboards, and supporting analyses that provide visibility into quality performance, audit findings, trends, and improvement opportunities.

• Ensure recurring quality reports are accurate, timely, and aligned with the needs of operational leaders and business partners.

• Compare quality results over time and evaluate progress against corrective actions, process improvements, and broader quality initiatives.

• Identify patterns, recurring findings, emerging risks, and potential reporting gaps within audit and operational data.

• Communicate analytical findings clearly to Quality Assurance, Operations, vendor, and business partners.

• Partner with subject matter experts, team leads, and supervisors to define new data-collection requirements and address reporting gaps.

• Develop new tracking and reporting capabilities as needed to support operating-model changes, business growth, or expansion.

Findings, Risk, and Corrective-Action Support

• Analyze audit findings to determine potential root causes, business impacts, customer impacts, and compliance risks.

• Distinguish isolated errors from recurring or systemic process issues requiring broader business attention.

• Provide audit data and supporting evidence to business owners responsible for developing corrective or preventive actions.

• Monitor identified issues and support reporting on remediation progress, recurring findings, and unresolved risks.

• Proactively identify potential future risks, process weaknesses, or control gaps based on audit results and operational trends.

• Engage appropriate business partners when findings require process, system, training, documentation, or control changes.

• Present audit results and supporting analysis to internal stakeholders and vendor partners in a clear, factual, and constructive manner.

• Support regulatory changes by helping identify necessary updates to audit tracking, workflows, job aids, standard operating procedures, and policies.

Process and Quality Improvement

• Use audit results, quality data, and operational observations to identify practical process-improvement opportunities.

• Lead or support project components involving enhancements to audit procedures, reporting, operational workflows, quality controls, or customer-facing processes.

• Partner with Operations, Compliance, vendors, and other business teams to evaluate identified gaps and develop sustainable solutions.

• Support the evaluation or development of new procedures and processes designed to mitigate compliance risk and improve customer outcomes.

• Help assess whether implemented changes address the original finding and produce the intended quality improvement.

• Recommend updates to controls, documentation, training, reporting, or monitoring based on audit evidence.

• Contribute technical and process expertise to continuous-improvement initiatives across Individual Dental Operations.

Audit Standards, Procedures, and Team Support

• Develop, maintain, and update audit procedures, standard operating procedures, job aids, workflows, and supporting documentation.

• Help ensure audit standards and procedures remain aligned with current business processes and applicable requirements.

• Provide technical direction and quality-related guidance to audit professionals and other team members.

• Serve as a resource for questions involving audit methodology, data interpretation, documentation, and complex findings.

• Support quality oversight activities for audit professionals while maintaining the role’s senior individual-contributor scope.

• Promote consistency through knowledge sharing, calibration, and clear documentation of audit expectations.

• Build effective working relationships with Quality Assurance, Operations, Compliance, vendor partners, and other matrix teams.

• Manage multiple assignments and priorities independently while adjusting to changing business needs.

Qualifications
Required

• 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 the 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 the ability to present findings to business and vendor partners.

• Ability to work independently, exercise sound judgment, and adjust priorities based on business needs.

• Strong collaboration skills and the 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+ years of related experience in a healthcare or insurance environment.

• Experience supporting Individual Dental, Individual and Family Plans, or another regulated health-benefits operation.

• Knowledge of applicable federal and state regulatory requirements affecting individual insurance operations.

• Understanding of Affordable Care Act and federal exchange requirements where relevant to the supported business.

• Experience with internal, external, regulatory, or vendor quality audits.

• Experience developing quality reporting, data-collection processes, audit analytics, or performance-tracking tools.

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

• Experience with OnBase, Microsoft Access, Minitab, or comparable data 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.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