Quality Analyst Auditor (Customer Service)
Quality Analyst Auditor (Customer Service)
As an integral member of the audit team, your role will involve performing in-depth audits and evaluations of calls, emails, and eligibility processes. Your key responsibilities include:
Your Job
Audit & Evaluation: Perform audits on calls, emails, and eligibility to ensure accuracy, consistency, and compliance with established procedures and standards.
Risk Management: Proactively identify and flag possible issues or risks related to processes and compliance.
Focus Audits & Projects: Participate in focus audits, projects, and third-party audits to support business objectives and ensure compliance.
Root Cause Analysis: Conduct root cause analysis on audit findings to understand the reasons behind discrepancies or errors and present findings during monthly meetings with Operations.
Continuous Improvement: Identify opportunities to improve both audit and operational processes, suggesting enhancements to increase efficiency and quality.
Audit Development: Contribute to the creation and enhancement of audit processes and procedures, ensuring they remain aligned with industry best practices.
Language Support: Provide support to auditors across different audit lines, especially when specific language knowledge is required.
Scope and dimensions
This role reports directly to the Quality Management Supervisor and operates within a collaborative, fast-paced team environment
Experience required
To be successful in this role, the following experience is preferred:
Medical Administration & Claims Experience: At least 2 years of experience in customer service or claims processing, ideally within a medical administration or claims-focused environment.
International Claims Processing: Experience with international insurance claims is a plus.
Audit & Coaching: Prior experience in audit, training, review, or coaching roles would be advantageous.
Your Profile
The ideal candidate for this role will be proactive, analytical, and effective in both individual and team settings. Key attributes include:
Strong Organizational Skills: High energy, results-oriented, with the ability to manage multiple tasks, meet deadlines, and prioritize effectively.
Analytical Thinking: Ability to analyze data, interpret information, and make informed decisions based on findings.
Problem-Solving & Guidance: Capable of seeking guidance on complex issues and resolving challenges independently or with team collaboration.
Communication Skills: Excellent verbal and written communication skills in English. Ability to present audit findings clearly, explain trends, and offer constructive feedback.
Active Listening & Rapport Building: Skilled in active listening, building rapport, and asking open/closed questions in a structured way to gather relevant information.
Coaching Ability: Strong coaching skills to share knowledge with peers and provide constructive feedback to support learning and development within the team.
Cultural Sensitivity: Ability to work effectively with individuals from different cultural backgrounds, tailoring communication and feedback to meet diverse learning styles and needs.
Team Player: Collaborative, with the ability to work both independently and as part of a team.
Empathy & Professionalism: Demonstrates a balance of professionalism and empathy when engaging with both staff and clients, mindful of their needs and experiences during the audit process.
Additional Skills and Qualifications
Familiarity with auditing software or tools (optional but beneficial).
Ability to work under pressure while maintaining attention to detail and accuracy.
Comfortable working in a fast-paced, dynamic environment and handling changes to priorities as needed.
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.