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 9/18/2026full-timeRemote • Texas • United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting quality reviews and audits, analyzing operational data, and providing actionable recommendations to enhance compliance and performance in healthcare operations. Proficient in developing audit procedures and maintaining accurate documentation while effectively communicating findings to stakeholders.

Highest-signal resume keywords

Quality ReviewsAudit DocumentationData AnalysisRegulatory ComplianceMicrosoft Excel

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality AuditingOperational AnalysisData ValidationRoot Cause AnalysisProcess Improvement

Soft Skills

Analytical ThinkingAttention to DetailCommunication SkillsCollaboration SkillsProblem-Solving

Tools & Technologies

Microsoft OfficeOnBaseMicrosoft AccessMinitab

Industry Keywords

Healthcare OperationsRegulatory RequirementsAffordable Care ActQuality AssuranceVendor Management

About the role

Key responsibilities & impact

Conduct and coordinate quality reviews and audits of internal operations and vendor-supported processes
Support review 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 activities among audit professionals, operational teams, and vendor partners
Collect, validate, analyze, and summarize audit and quality data
Develop and maintain reports, dashboards, and analyses covering quality performance, findings, trends, and improvement opportunities
Identify patterns, recurring findings, emerging risks, and reporting gaps
Communicate analytical findings to Quality Assurance, Operations, vendor, and business partners
Define data-collection requirements and develop tracking and reporting capabilities
Analyze findings for root causes, business impacts, customer impacts, and compliance risks
Support corrective and preventive actions, remediation tracking, and unresolved-risk reporting
Present audit results and supporting analysis to stakeholders and vendor partners
Support regulatory changes by updating audit tracking, workflows, job aids, procedures, and policies
Identify process-improvement opportunities and lead or support improvement project components
Partner with Operations, Compliance, vendors, and other 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 supporting 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 while adapting to changing business needs

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 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 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+ 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
Preferred: ability to travel occasionally based on business needs
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/home working permitted, subject to cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload
Occasional travel based on business needs
Equal employment opportunity protections
Reasonable accommodation support for the online application process
Tobacco-free policy