Quality Review and Audit Analyst

The Position

We are looking for a quality-focused professional to support Quality Review and Audit activities within Cigna Healthcare. This role performs audits, analyzes results, identifies trends and opportunities for improvement, and partners with team members and business stakeholders to help promote accuracy, consistency, and strong operational outcomes.

The position applies professional knowledge and established audit techniques to review work, develop audit findings and reports, and support continuous improvement. The successful candidate will be detail-oriented, analytical, and comfortable working across multiple processes while balancing quality, productivity, and business priorities.

Key Responsibilities

• Perform quality reviews and audits using established audit guidelines, procedures, and quality standards.
• Develop, document, and distribute audit reports and analyses for review and communication to appropriate stakeholders.
• Identify audit trends, errors, and process gaps and recommend opportunities to improve departmental processes and procedures.
• Assist in the development, documentation, and ongoing improvement of audit guidelines and review processes.
• Support third-party audits by completing questionnaires, validating selected claims or transactions, researching findings, and responding to identified errors.
• Analyze audit results and help identify root causes and recurring trends that may require additional review or corrective action.
• Partner with team members and business areas to clarify audit findings and promote consistent application of established processes and requirements.
• Serve as a subject matter expert and resource for team members as needed.
• Identify learning opportunities based on audit results and recommend or assist with training designed to address recurring error trends.
• Provide guidance, coaching, and direction to more junior members of the Quality Review and Audit team.
• Support continuous improvement efforts that strengthen quality, accuracy, efficiency, and the overall customer experience.

Required Skills and Experience

• Experience working with the Diamond platform.
• Experience performing quality reviews, audits, quality assurance, or similar analytical work.
• Strong analytical and problem-solving skills with the ability to identify trends, discrepancies, and potential process improvements.
• Strong attention to detail and ability to consistently apply established procedures and audit criteria.
• Ability to document findings clearly and communicate results to team members and business partners.
• Strong written and verbal communication skills.
• Ability to manage multiple priorities and work independently while contributing effectively within a team environment.

Preferred Skills and Experience

• GHB NA experience.
• Experience within healthcare, health insurance, benefits, eligibility, claims, premium, or related operational functions.
• Experience identifying root causes, trends, and opportunities for process or quality improvement.
• Experience serving as a subject matter expert or providing guidance, coaching, or training to others.
• Experience working in a quality-focused environment that requires strong documentation, accuracy, and adherence to established procedures.

About The Cigna Group

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.