Quality Review and Audit Lead Analyst

3 weeks ago

Orlando, Florida, United States The Cigna Group Full time

The Quality Review and Audit Analyst will independently develop test plans for group benefit design request and track and report progress to the team to ensure deadlines are met. This person will perform verification/QA and system testing before implementation and within contractual timeframe agreements. The Quality Review and Audit Analyst will provide consultative support to internal and external clients by researching and assisting with the resolution of benefit design and claims issues. This person will assist with more complex setups or projects as needed and use independent judgment and discretion.

The Quality Review and Audit Analyst may recommend changes in processing procedures and utilize in-depth professional knowledge and acumen to develop models and procedures, and monitor trends within Quality Review and Audit.

RESPONSIBILITIES:

  • Manage new and existing client testing needs/requirements.
  • Create end-to-end test scenarios and execute test plans.
  • Monitor the daily status of client implementations.
  • Assist in collaboration efforts with internal partners to obtain necessary information.
  • Build relationships and daily partnership with cross-functional teams.
  • Communicate results in a client/vendor facing environment when applicable.
  • Perform other tasks or special duties as assigned.
  • Identify, create, and update SOPs and/or training materials in collaboration with the Operations Testing Quality Assurance team.

QUALIFICATIONS:

  • High School Diploma or GED; Bachelor's degree preferred
  • 2+ years' experience using advanced Excel features (V-lookup, pivot tables, macros) is required
  • 2+ years' leading/managing projects from start to finish is required
  • Strong working knowledge of claim adjudication and/or retail systems and requirements preferred
  • Background in Healthcare or Pharmacy is a plus
  • Knowledge of writing and running queries in SQL is a plus
  • Excellent verbal and written communication skills
  • Solid organizational and demonstrated skills in prioritizing workload is a must
  • Strong interpersonal and collaboration skills; Effectively able to work well independently and within a team environment

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 Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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 require reasonable accommodation in completing the online application process, please support. Do not an update on your application or to provide your resume as you will not receive a response.

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.


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