Quality Review and Audit Analyst, Medicare
4 weeks ago
Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply
Our people make all the difference in our success.
Work Location - Remote, United StatesBilingual Required - English/Spanish
Summary
General Purpose: To perform standardized telephonic evaluations of both internal and external agents in order to ensure compliance to CMS and Cigna rules and regulations
Responsibilities
- Performs monitoring of internal partners, external partners (70+ FDRs with 1,400 down-lines and 20,000 agents)
- Provides feedback to agents and managers as well as external partners regarding agent/agency performance and compliance.
- Maintains a strong rapport with telephonic internal and external partners
- May be directly involved in complex operational audits and monitoring or regulatory inquiries to provide expertise and guidance on technical or procedural issues
- Performs annual audit of CMS' Foreign Language-TTY study to ensure that agents adhere to guidelines enforced by CMS
- Performs ad hoc review of data to improve processes and develop remediation as necessary
- Ensures CMS and Cigna audit readiness
- Ensures that internal and external partners adhere to filed telephonic scripts
Qualifications
- High School Diploma and 3 or more years work related experience required, Bachelor's degree preferred
- Bilingual - Englis/ Spanish required
- Experience working in a Telesales environment preferred
- Knowledge of CMS and Cigna compliance policies and procedures preferred
- High attention to detail, quality and accuracy
- Strong coordination and organizational skills
- Ability to communicate effectively and follow-up where needed
- Fast-learner and multi-tasking skills
- Ability to work independently and within a team environment in a matrixed environment required
- Strong interpersonal and prioritization skills preferred
- Sales and/or training experience recommended
- Ability to handle multiple assignments, projects and deliverables simultaneously required
- Strong computer skills required (Microsoft Office Suite products preferred)
- Excellent listening, written and verbal communication skills required
- Adaptability, flexibility, and ability to manage through change in a fast-paced environment required
- Goal oriented, resourceful, personally accountable and self-directed
- Ability to effectively collaborate across the organization
- Process-oriented with organization and planning skills among competing responsibilities and tasks
- Proactively seek opportunities for improvement
- Ability to speak to different audiences
Competencies
- Informing, Organizing, Priority Setting, Perseverance, Problem solving, Customer Focus, Organizational Agility, Interpersonal Savvy
Tools
Ensure familiarity and expertise in Cigna systems including but not limited to Microsoft Office, CRM, and SharePoint
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.For this position, we anticipate offering an hourly rate of USD / hourly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna.
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.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
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