[Hiring] Quality Review and Audit Advisor @The Cigna Group

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 large-scale 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

• Lead or co-lead testing activities for new client implementations, benefit/clinical/pricing changes, and existing business initiatives
• Partner with clients and Account, Implementation, Operations, and Product teams to understand business intent and translate requirements into comprehensive testing scenarios
• Develop, validate, and execute detailed test plans aligned to client expectations and delivery timelines
• Create, review, and validate testing data to ensure quality, completeness, and accuracy
• Ensure testing activities are completed within established deadlines
• Identify, document, track, and escalate defects and issues to appropriate teams
• Partner with stakeholders to support issue resolution and drive optimal outcomes
• Communicate testing status, risks, and challenges to Operations Testing leadership
• Produce and maintain testing status and progress reporting
• Develop and maintain reusable quality controls, testing procedures, and documentation to support implementations and ongoing business changes
• Support lessons-learned activities and provide actionable recommendations to enhance processes
• Identify opportunities to improve testing tools, workflows, and cross-functional coordination
• Support pilot initiatives and strategic department projects that enhance efficiency and client satisfaction
• Participate in project status meetings, client calls, and ad hoc working sessions
• Contribute to training, documentation, and knowledge sharing activities
• Mentor and support less experienced team members
• Promote team effectiveness through collaboration, best practice sharing, and engagement in special projects

Benefits

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