Quality Audit Analyst

Overview

The Quality Audit Analyst plays a vital role in maintaining high standards of performance within service delivery teams by conducting thorough quality audits, validating case accuracy, detecting process inefficiencies, and ensuring compliance with internal protocols, industry regulations, and customer commitments.

Key Responsibilities

• Carry out regular and focused quality audits across various operational sectors including Claims, Eligibility, Administration, Customer Service, and Client Support.
• Evaluate accuracy, completeness, adherence to SOPs, and regulatory compliance in system entries, documentation, and communication processes.
• Guarantee objectivity and consistency in audit scoring aligned with the quality assurance framework.
• Deliver clear, constructive feedback and coaching support to team members and supervisors to promote continuous quality improvement and adherence to standards.
• Identify high-risk errors and patterns requiring escalation, maintaining meticulous audit documentation for governance and reporting purposes.
• Detect potential compliance gaps, regulatory violations, or risks and promptly report significant issues to leadership.
• Recommend enhancements to operational processes, documentation, and training materials, including SOP revisions, based on audit findings.
• Participate in projects and initiatives aimed at improving service quality and explore automation opportunities to enhance process effectiveness.
• Define and track relevant quality metrics, analyze error trends, and support root cause investigation to address systemic challenges.
• Collaborate closely with supervisors, trainers, and quality assurance teams to maintain uniform quality standards and support the implementation of process changes and quality framework updates.
• Engage in calibration sessions to ensure audit scores are fair and consistent across teams.

Candidate Profile

• Possess 3 to 5 years of experience in operations or quality functions, preferably with background knowledge in claims processing.
• Proficient in the use of operational systems and software including workflow management tools, QA platforms, CRM systems, and Excel.
• High level of attention to detail and precision in audit assessments.
• Strong analytical skills with the ability to interpret data and identify quality trends.
• Effective written and oral communicator capable of delivering balanced and constructive feedback.
• Demonstrated ability to prioritize tasks, meet deadlines, and work independently.
• Solid problem-solving aptitude with a process-oriented approach.
• Customer-centric mindset committed to enhancing quality and service outcomes.
• Fluency in English is essential; additional language skills are an advantage.
• Exhibits integrity, fairness, and impartiality when conducting audits.

Key Competencies

• Strong focus on quality and compliance to produce error-free outputs.
• Analytical thinker using data-driven insights and root cause analysis.
• Exceptionally detail-oriented reviewing work thoroughly.
• Collaborative spirit fostering positive interactions with colleagues and supervisors.
• Effective communication skills in both written and verbal forms.
• Proficient in managing time and meeting audit deadlines.
• Disciplined in following procedures, SOPs, and governance requirements.
• Committed to continuous improvement and identifying efficiency opportunities.
• Maintains objectivity and fairness throughout auditing processes.
• Dedicated to delivering results that safeguard the customer experience.

About the Employer

The Cigna Group is dedicated to enhancing health and well-being throughout life. Through comprehensive guidance and empowerment, we assist customers in navigating healthcare systems to make informed choices.

Equal Opportunity

Applicants are evaluated without regard to race, color, age, disability, sex, pregnancy, sexual orientation, gender identity, veteran status, religion, national origin, marital status, genetic information, public assistance status, citizenship, or any other protected characteristic.

Accommodation

If applicants need reasonable accommodations during the application process, support is available upon request through designated contact channels.