[Hiring] Quality Review and Audit Advisor @Cigna Healthcare

Role Description

The Quality Review and Audit Advisor provides expert execution for complex, high impact Quality Assurance and Audit initiatives. This role is responsible for planning, leading, and delivering largescale and cross-functional testing efforts that ensure accurate benefit, clinical, and pricing configuration while supporting successful client implementations and operational changes.

Operating in a fast paced, highly collaborative environment, the Advisor exercises sound judgment, foresight, and creativity to develop testing strategies, evaluate issues, and drive resolution efforts that directly impact clients, members, providers, and vendor partners. The role partners closely with implementation, account management, operations, product, and regulatory teams—and works directly with clients as needed—to ensure thorough test planning, execution, validation, and clear communication of results.

A core focus of the position is client centric benefit and clinical testing, validation of pricing and configuration accuracy, and deep understanding of client setup and operational processes. The Advisor supports regulatory and operational audits, contributes to procedural and control enhancements, and ensures appropriate documentation, milestone management, and communication across initiatives. Through this work, the role enables accurate benefit setup and mitigates downstream risk for clients, internal partners, and members.

The Quality Review and Audit Advisor also plays a key role in department level continuous improvement by identifying opportunities for process rigor, implementing enhancements, and supporting operational excellence. The position supports multiple Lines of Business—including HealthPlan, Medicare, Medicaid, Exchange, Commercial, DoD, and Cigna—and is considered client facing, with expertise in benefits, clinical configuration, and pricing setup.

Upon mastery of key testing initiatives, the Advisor is recognized as a subject matter expert and provides thought leadership within Quality Review and Audit, collaborating across the broader enterprise to support complex business objectives and drive meaningful quality outcomes.

Qualifications

• Bachelor’s degree required and 3+ years of experience in operations, benefits/clinical, claims processing, testing, quality assurance, audit, or a related role required – or – 6+ years of related experience
• Experience supporting HealthPlan, Medicare, Medicaid, Exchange, Commercial, DoD, and/or Cigna Lines of Business
• Clinical, pharmacy, or healthcare-related background preferred
• Project Management Certification or skillset is preferred
• Strong business acumen with the ability to quickly learn new business domains and processes
• Proven ability to work autonomously, manage competing priorities, and meet critical deadlines
• Proficiency in Microsoft tools including advanced Excel, PowerPoint, Word, Outlook, and SharePoint

Requirements

• 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.

Benefits

• Annual salary of 78,800 - 131,300 USD / yearly, depending on relevant factors, including experience and geographic location.
• Eligible to participate in an annual bonus plan.
• Comprehensive range of benefits, including medical, vision, dental, and well-being and behavioral health programs.
• 401(k), company paid life insurance, tuition reimbursement.
• A minimum of 18 days of paid time off per year and paid holidays.

Company Description

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.