Quality Audit Analyst

As a Quality Audit Analyst at Cigna, you will play a pivotal role in ensuring operational excellence across service delivery teams by conducting comprehensive quality audits. Your responsibilities include reviewing case accuracy, identifying process gaps, and ensuring strict adherence to internal procedures, regulatory guidelines, and customer commitments. You will provide actionable feedback to team leaders and staff, support continuous improvement initiatives, and contribute to fostering a culture of quality, compliance, and consistency within Operations. This role serves as a critical bridge between frontline teams, supervisors, and quality leaders by delivering evidence-based recommendations and conducting root-cause analyses to enhance daily operations. Key responsibilities include routine and targeted audits across operational workstreams such as Claims, Eligibility, Admin, Customer Service, and Client Support, with a focus on assessing accuracy, completeness, compliance, and alignment to SOPs and regulatory requirements. You will review system entries, documentation, case handling, and communication quality, ensuring audit scoring is objective, consistent, and aligned with the quality framework. Additionally, you will provide constructive audit feedback, highlight high-risk errors and recurring themes for escalation, support team leaders in delivering quality coaching sessions, and maintain accurate audit logs and records for reporting and governance purposes.

Bachelor’s degree in a relevant field (e.g., Business Administration, Healthcare Management, Finance, or related discipline); 2+ years of experience in quality assurance, audit, compliance, or operations within the healthcare or insurance industry; Strong knowledge of regulatory guidelines (e.g., HIPAA, GDPR, or local healthcare regulations); Proficiency in audit methodologies and frameworks; Excellent analytical and problem-solving skills; Strong attention to detail and ability to identify process gaps; Effective communication and coaching skills to provide actionable feedback; Experience with audit software or tools (e.g., CRM systems, case management platforms) is a plus; Certification in quality assurance or audit (e.g., CQA, CIA) is advantageous.