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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 utilizing Microsoft Excel for organizing and analyzing audit data.
Highest-signal resume keywords
Audit ProceduresQuality AssuranceMicrosoft ExcelHealthcare OperationsAttention to Detail
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 EntryError IdentificationAnalytical SkillsDocumentationScoring GuidelinesCompliance RequirementsProcess ImprovementCall Monitoring
Soft Skills
Communication SkillsTeam CollaborationProblem-SolvingFlexibilityAttention to Detail
Tools & Technologies
Microsoft OfficeReporting ToolsAudit Tracking SystemsData Validation ToolsQuality Control Systems
Industry Keywords
Healthcare OperationsClaims ReviewCustomer ServiceEligibilityContact Center OperationsRegulated EnvironmentsIndividual Dental PlansQuality StandardsAudit GuidelinesBusiness Requirements
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 and maintain supporting documentation
- Identify and document errors, procedural gaps, recurring observations, and potential trends
- Escalate unusual circumstances, compliance concerns, customer-impacting issues, and technical barriers
- Enter, validate, organize, and summarize audit data using designated systems, trackers, reporting tools, Microsoft Excel, and other approved tools
- Assist with standard audit reports, summaries, report distribution, questionnaires, case validation, error responses, and evidence collection
- Participate in calibration sessions, training, coaching, job shadowing, and knowledge-sharing activities
- Maintain current knowledge of procedures, audit guidance, products, systems, and business requirements
- Identify process, procedure, audit-guidance, and documentation gaps
- Assist with quality and process-improvement initiatives, testing, and validation activities
- Build relationships with Quality Assurance colleagues and matrix partners
- Support onboarding through job shadowing or process demonstration when assigned
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
- Experience in Individual Dental, Individual and Family Plans, or another healthcare or insurance operation
- Familiarity with regulated operating environments and compliance requirements
- Experience entering, validating, or summarizing audit and quality data
- Experience using Microsoft Excel or comparable tools to organize information and identify basic trends
- Knowledge of customer service, benefits, eligibility, claims, or contact center operations
- Ability to travel occasionally based on business needs
Benefits
Comp & perks- Remote work option, subject to required cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload
- Tobacco-free policy
- Reasonable accommodation support for the online application process