[Hiring] Quality Review and Audit Analyst @Cigna Healthcare

Role Description

The Quality Review and Audit Analyst conducts quality reviews and audits of customer interactions, operational transactions, and supporting system activity within Individual Dental Operations. The role evaluates work against established procedures, quality standards, business requirements, and applicable regulatory expectations.

• The Analyst accurately scores reviews, maintains audit documentation, records audit results, and communicates identified errors or process concerns.
• This role contributes to quality reporting, calibration, process improvement, and customer experience efforts by identifying issues and providing reliable audit information to Quality Assurance leadership and business partners.

Qualifications

• Relevant experience in healthcare operations, customer service, benefits, eligibility, claims, contact center operations, quality assurance, auditing, or a comparable business environment.
• Ability to follow detailed audit procedures, scoring guidelines, and quality standards.
• Strong attention to detail and commitment to accurate documentation and data entry.
• Ability to identify errors and communicate findings clearly and professionally.
• Basic analytical and problem-solving skills.
• Ability to manage assigned work and meet established deadlines.
• Strong written and verbal communication skills.
• Ability to work effectively in a team and matrixed business environment.
• Proficiency with Microsoft Office applications.
• Ability to learn and use systems required to perform assigned audit work.
• Flexibility to adjust to changing procedures, workload, and business needs.

Requirements

• Conduct assigned quality reviews through call monitoring, transaction review, claim review, or examination of relevant operational systems and records.
• Evaluate work against established procedures, audit guidelines, quality standards, and applicable business requirements.
• Apply approved scoring criteria and quality controls consistently.
• Complete routine and moderately complex audits within established productivity, accuracy, and timeliness expectations.
• Record audit results accurately in designated systems, trackers, or reporting tools.
• Maintain complete documentation supporting audit scores, identified errors, and review outcomes.
• Identify questions or unusual circumstances and escalate them to a Senior Analyst, Lead Analyst, or Quality Assurance leader.
• Protect customer and business information in accordance with applicable privacy, security, and records-management requirements.
• Identify and document errors, procedural gaps, and instances in which established quality requirements were not met.
• Provide clear examples and supporting facts when communicating audit findings.
• Recognize recurring observations within assigned work and share potential trends with the Senior Analyst, Lead Analyst, or supervisor.
• Communicate system problems or technical barriers that affect audit completion or accuracy.
• Participate in discussions regarding audit findings and provide supporting case information when requested.
• Avoid making unsupported conclusions beyond the evidence available in the audit record.
• Escalate potential compliance or customer-impacting concerns promptly through established channels.
• Enter audit information accurately and completely to support quality-data collection and reporting.
• Review entered data for completeness and correct identified errors.
• Assist with the preparation and distribution of standard audit reports and summaries.
• Use Microsoft Excel and other approved tools to organize audit information and support basic trend identification.
• Provide audit records, examples, or supporting documentation needed for quality reporting and analysis.
• Assist with questionnaires, selected case validation, error responses, or evidence collection for internal, external, or third-party reviews.
• Follow established data definitions and reporting procedures to promote reliable quality information.
• Participate in calibration sessions to strengthen understanding and consistent application of audit standards.
• Bring appropriate cases or questions forward for calibration or technical review.
• Incorporate calibration decisions and feedback into subsequent audit work.
• Maintain current knowledge of applicable procedures, audit guidance, products, systems, and business requirements.
• Ask questions and seek guidance when established standards do not clearly address a situation.
• Participate in training, coaching, job shadowing, and other development activities.
• Support team knowledge sharing when the Analyst has relevant subject matter expertise.
• Identify and communicate potential gaps in processes, procedures, audit guidance, or supporting documentation.
• Assist with defined components of quality or process-improvement initiatives.
• Provide frontline audit observations to team members and business partners involved in evaluating identified issues.
• Support testing or validation activities when assigned.
• Build effective working relationships with Quality Assurance colleagues and matrix partners.
• Provide technical assistance to colleagues within the Analyst’s demonstrated area of knowledge.
• Support onboarding activities through job shadowing or process demonstration when assigned.

Benefits

• Flexibility to work from home with a reliable internet connection.
• Support for professional development and training opportunities.