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Quality Review and Audit Senior Representative

thecignagroup.com Logo

The Cigna Group

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Location:
India , Bengaluru

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Category:
Quality Control

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Contract Type:
Not provided

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Salary:

Not provided
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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

Additional Information:

Job Posted:
March 20, 2026

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