Position Summary

The Quality Review and Audit Analyst conducts quality reviews and audits of customer interactions, operational transactions, and supporting system activity within Individual Dental Operations. The role evaluates work against established procedures, quality standards, business requirements, and applicable regulatory expectations.

The Analyst accurately scores reviews, maintains audit documentation, records audit results, and communicates identified errors or process concerns. The position applies established techniques and procedures to routine and moderately complex assignments and escalates questions requiring additional technical or business interpretation.

This role contributes to quality reporting, calibration, process improvement, and customer experience efforts by identifying issues and providing reliable audit information to Quality Assurance leadership and business partners.

Core Accountabilities and Responsibilities

Quality Review and Audit Execution

• Conduct assigned quality reviews through call monitoring, transaction review, claim review, or examination of relevant operational systems and records.
• Evaluate work against established procedures, audit guidelines, quality standards, and applicable business requirements.
• Apply approved scoring criteria and quality controls consistently.
• Complete routine and moderately complex audits within established productivity, accuracy, and timeliness expectations.
• Record audit results accurately in designated systems, trackers, or reporting tools.
• Maintain complete documentation supporting audit scores, identified errors, and review outcomes.
• Identify questions or unusual circumstances and escalate them to a Senior Analyst, Lead Analyst, or Quality Assurance leader.
• Protect customer and business information in accordance with applicable privacy, security, and records-management requirements.

Findings and Issue Identification

• Identify and document errors, procedural gaps, and instances in which established quality requirements were not met.
• Provide clear examples and supporting facts when communicating audit findings.
• Recognize recurring observations within assigned work and share potential trends with the Senior Analyst, Lead Analyst, or supervisor.
• Communicate system problems or technical barriers that affect audit completion or accuracy.
• Participate in discussions regarding audit findings and provide supporting case information when requested.
• Avoid making unsupported conclusions beyond the evidence available in the audit record.
• Escalate potential compliance or customer-impacting concerns promptly through established channels.

Audit Data and Reporting Support

• Enter audit information accurately and completely to support quality-data collection and reporting.
• Review entered data for completeness and correct identified errors.
• Assist with the preparation and distribution of standard audit reports and summaries.
• Use Microsoft Excel and other approved tools to organize audit information and support basic trend identification.
• Provide audit records, examples, or supporting documentation needed for quality reporting and analysis.
• Assist with questionnaires, selected case validation, error responses, or evidence collection for internal, external, or third-party reviews.
• Follow established data definitions and reporting procedures to promote reliable quality information. The source description specifically assigns the Analyst responsibility for accurate audit-data entry, initial reporting and analysis, report distribution, and support for third-party audits. 

Calibration and Knowledge Development

• Participate in calibration sessions to strengthen understanding and consistent application of audit standards.
• Bring appropriate cases or questions forward for calibration or technical review.
• Incorporate calibration decisions and feedback into subsequent audit work.
• Maintain current knowledge of applicable procedures, audit guidance, products, systems, and business requirements.
• Ask questions and seek guidance when established standards do not clearly address a situation.
• Participate in training, coaching, job shadowing, and other development activities.
• Support team knowledge sharing when the Analyst has relevant subject matter expertise.

Process and Team Support

• Identify and communicate potential gaps in processes, procedures, audit guidance, or supporting documentation.
• Assist with defined components of quality or process-improvement initiatives.
• Provide frontline audit observations to team members and business partners involved in evaluating identified issues.
• Support testing or validation activities when assigned.
• Build effective working relationships with Quality Assurance colleagues and matrix partners.
• Provide technical assistance to colleagues within the Analyst’s demonstrated area of knowledge.
• Support onboarding activities through job shadowing or process demonstration when assigned.

Qualifications

Required

• 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.

Preferred

• 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.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email [email protected] for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.