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Quality Review and Audit Analyst, Individual Dental Operations
The Cigna Group. Conduct quality reviews through call monitoring, transaction review, claim review, or examination of operational systems and records .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in conducting audits and quality reviews within healthcare operations, ensuring compliance with regulatory standards and business requirements. Proficient in data entry, documentation, and analysis to support quality improvement initiatives.
Highest-signal resume keywords
Audit ProceduresQuality AssuranceMicrosoft ExcelAttention to DetailHealthcare Operations
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
AuditingQuality ReviewsData EntryAnalytical SkillsDocumentationError IdentificationTrend AnalysisCall MonitoringTransaction ReviewClaims Review
Soft Skills
Communication SkillsTeam CollaborationProblem-SolvingFlexibilityAttention to Detail
Tools & Technologies
Microsoft OfficeReporting ToolsTracking Systems
Industry Keywords
Healthcare OperationsCustomer ServiceBenefitsEligibilityClaimsContact Center OperationsRegulatory Compliance
About the role
Key responsibilities & impact- Conduct quality reviews through call monitoring, transaction review, claim review, or examination of operational systems and records
- Evaluate work against procedures, audit guidelines, quality standards, business requirements, and regulatory expectations
- Apply scoring criteria and quality controls consistently
- Complete routine and moderately complex audits within productivity, accuracy, and timeliness expectations
- Record audit results in designated systems, trackers, and reporting tools
- Maintain documentation supporting audit scores, errors, and review outcomes
- Identify and document errors, procedural gaps, and unmet quality requirements
- Communicate audit findings with clear examples and supporting facts
- Recognize recurring observations and share potential trends
- Escalate unusual, compliance, customer-impacting, or technically complex concerns
- Enter, validate, and organize audit data for quality reporting
- Assist with standard audit reports, summaries, report distribution, questionnaires, case validation, error responses, and evidence collection
- Use Microsoft Excel and approved tools for basic trend identification
- Participate in calibration sessions and incorporate feedback into audit work
- Maintain knowledge of procedures, products, systems, and business requirements
- Participate in training, coaching, job shadowing, and knowledge-sharing activities
- Identify process, procedure, audit-guidance, and documentation gaps
- Assist with quality and process-improvement initiatives, testing, and validation
- Build relationships with Quality Assurance colleagues and matrix partners
- Support onboarding through job shadowing or process demonstration
Requirements
What you’ll need- 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
- Previous experience conducting audits, quality reviews, call monitoring, transaction reviews, or claims reviews (preferred)
- Experience in Individual Dental, Individual and Family Plans, or another healthcare or insurance operation (preferred)
- Familiarity with regulated operating environments and compliance requirements (preferred)
- Experience entering, validating, or summarizing audit and quality data (preferred)
- Experience using Microsoft Excel or comparable tools to organize information and identify basic trends (preferred)
- Knowledge of customer service, benefits, eligibility, claims, or contact center operations (preferred)
- Ability to travel occasionally based on business needs (preferred)
- If working at home, internet connection must be through a cable broadband or fiber optic provider with speeds of at least 10Mbps download/5Mbps upload
Benefits
Comp & perks- Remote work arrangement
- Cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload for home working
- Equal employment opportunity protections
- Reasonable accommodation for the online application process
- Tobacco-free policy and access to a qualifying smoking cessation program where applicable