Quality Review and Audit Lead Analyst, Individual Dental Operations

The Cigna Group

. Conduct and coordinate quality reviews and audits of internal operations and vendor-supported processes .

Posted 9/17/2026full-timeRemote • Florida • United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting quality reviews and audits, with a strong focus on data analysis, compliance, and operational improvements. Proficient in developing audit procedures and maintaining accurate documentation while effectively communicating findings to stakeholders.

Highest-signal resume keywords

Quality AuditingData AnalysisRegulatory ComplianceMicrosoft Excel ProficiencyHealthcare Operations Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality ReviewsAudit DocumentationOperational AnalysisData InterpretationCorrective ActionsProcess ImprovementReporting CapabilitiesEvidence CollectionRoot Cause AnalysisPerformance Tracking

Soft Skills

Analytical SkillsAttention to DetailCommunication SkillsCollaboration SkillsProblem-Solving Skills

Tools & Technologies

Microsoft OfficeOnBaseMicrosoft AccessMinitab

Industry Keywords

Healthcare OperationsInsurance OperationsAffordable Care ActFederal Exchange RequirementsQuality Assurance

About the role

Key responsibilities & impact

Conduct and coordinate quality reviews and audits of internal operations and vendor-supported processes
Support audit planning, case selection, evidence collection, documentation, analysis, and reporting
Evaluate complex audit findings and engage business owners or subject matter experts when needed
Maintain accurate audit documentation supporting findings, conclusions, and recommended actions
Monitor audit activities and deliverables against regulatory turnaround requirements and internal expectations
Collect and organize evidence for enterprise, regulatory, internal, or external audits
Identify compliance concerns and escalate material findings or risks
Support calibration among audit professionals, operational teams, and vendor partners
Collect, validate, analyze, and summarize audit and quality data
Develop and maintain reports, dashboards, and analyses on quality performance, findings, trends, and improvement opportunities
Identify patterns, recurring findings, emerging risks, and reporting gaps
Communicate analytical findings to Quality Assurance, Operations, vendors, and business partners
Define data-collection requirements and address reporting gaps
Develop tracking and reporting capabilities supporting operating-model changes and business growth
Analyze root causes, business and customer impacts, and compliance risks of audit findings
Support corrective and preventive actions, remediation tracking, and unresolved-risk reporting
Present audit results and analysis to internal stakeholders and vendor partners
Support regulatory changes through updates to audit tracking, workflows, job aids, procedures, and policies
Identify process-improvement opportunities using audit results and operational observations
Lead or support enhancements to audit procedures, reporting, workflows, quality controls, and customer-facing processes
Partner with Operations, Compliance, vendors, and business teams to develop sustainable solutions
Evaluate whether implemented changes address findings and improve quality
Recommend updates to controls, documentation, training, reporting, and monitoring
Develop, maintain, and update audit procedures, SOPs, job aids, workflows, and documentation
Provide technical direction and quality-related guidance to audit professionals and team members
Serve as a resource for audit methodology, data interpretation, documentation, and complex findings
Manage multiple assignments and priorities independently

Requirements

What you’ll need

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 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 presenting findings to business and vendor partners
Ability to work independently, exercise sound judgment, and adjust priorities based on business needs
Strong collaboration skills and 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
Preferred: three or more years of related experience in a healthcare or insurance environment
Preferred: experience supporting Individual Dental, Individual and Family Plans, or another regulated health-benefits operation
Preferred: knowledge of applicable federal and state regulatory requirements affecting individual insurance operations
Preferred: understanding of Affordable Care Act and federal exchange requirements where relevant
Preferred: experience with internal, external, regulatory, or vendor quality audits
Preferred: experience developing quality reporting, data-collection processes, audit analytics, or performance-tracking tools
Preferred: experience supporting corrective actions, process improvements, or quality-improvement projects
Preferred: experience with OnBase, Microsoft Access, Minitab, or comparable data and reporting tools
If working at home, cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload is required

Benefits

Comp & perks

Remote work arrangement
Ability to travel occasionally based on business needs
Equal employment opportunity protections
Reasonable accommodation support for the online application process
Tobacco-free policy
Consideration of qualified applicants with criminal histories consistent with applicable laws