Quality Review and Audit Senior Representative Job at The Cigna Group (Bengaluru)

Job Description

This position will be responsible for auditing the work within the CGHB Organization. As a member of the CGHB Quality Audit Team, the incumbent will have the ability and be expected to drive change, and positively impact the accuracy and efficiency of operations.

Job Responsibility

Completes audits to ensure claim advocates understanding of current Cigna policies and procedures, including job aids, Articles, and alerts
Interfaces with matrix partners in relation to quality audit process, specifically address gaps identified through audit process and recommendations for gap closure
Completes review of documents related to audits to help ensure direction is clear and consistent with processing of work
Provides feedback to operations where updates may be required to drive consistency and accuracy
Completes inter-rater reliability exercises with peers, other quality roles and business owners to provide insight into review process
Excellent skills in navigation and use of all applications related to Diamond claim role including but not limited to: Diamond, SAM3, Outlook, CPF, Network X-Pricer, Salesforce, I Provider, Envoy, Facets, Visium, X-Net, Knowledge Xchange, PIMS (SANP), etc
Provides a quality review voice in various workgroups pertaining to workflows, documentation and issues driving errors, in an attempt to continuously improve results
Supports, educates, and reinforces the workflows, processes, tools for the nurses
Provides support for internal and GSP sites based on business needs
Support Coaching and Training program and responsibilities when needed to Support for Business needs and requirements which could include answering Q&A, facilitate trainings, and Coaching’s

Requirements

2+ years of overall experience processing claims
at least 1+ year Diamond claim processing experience required
US & International claims experience preferred
Customer Service Driven
ability to meet and exceed the internal partner and external customer expectations
Proven outcomes in critical thinking and decision-making outcomes
Proven outcomes in problem solving skills
utilization of technical skills and resources to ensure accuracy of final resolution
Proven process improvement skills: ability to assess trends, processes, and barriers to drive positive outcomes for claim resolutions
Must be comfortable and effective working in a diverse environment
office, and/or virtual environment
Strong organization and time management skills
effectively adapts to multiple and/or competing priorities
Strong communication skills, both verbal and written
ability to adapt communication to the individual or audience

The Cigna Group - All Job Offers

Select Country

Quality Review and Audit Senior Representative

Job Description

Job Responsibility

Requirements

Looking for more opportunities?

Quality Review and Audit Senior Representative

Senior Manager Quality Assurance: Incoming Quality and Warehouse

Clinical Service Desk - Helpdesk Senior Representative

Senior Quality Inspector

Senior Quality Engineer

Senior Supplier Quality Engineer

Quality Assurance Senior Manager

Quality Compliance Senior Manager - Labelling & Regulatory Affairs

Manager Quality Control (Micro and Sample Management)

Our AI answers in your language