[Hiring] Quality Review and Audit Lead Analyst @The Cigna Group

Role Description

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.

Qualifications

• 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.

Requirements

• 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.

Benefits

• 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.