Job description

Job Summary:
This is a professional role contributing to the success of multiple department goals through the management of assigned tasks. This Quality Review and Audit Senior Representative is responsible for meeting key deliverables within expected time frames. Deliverables are inclusive of performing quality assurance reviews and communicating and documenting audit findings with limited supervision.

Core Responsibilities:
Call provider offices to validate online provider directory information monthly.
Assess the accuracy of records and processes related to provider directory activity, grievances, CTMs, call trackers, and provider terminations to ensure compliance with policies and procedures.
Act as a subject matter expert and resource for our internal business partners.
Review documentation in multiple systems to identify errors and trends.
Monitor departmental mailbox daily and respond or route emails appropriately.
Work collaboratively with team members to present audit findings in committee meetings.
Actively engage in quality initiatives to address error trends and process improvement opportunities.
Meet with internal business partners to identify root cause and track/remediate identified errors/compliance risks and gaps.

Minimum Qualifications:
Bachelor's Degree or higher strongly preferred or equivalent work experience required.
3+ years' experience working with provider data for Medicare Advantage and Medicaid lines of business.
Strong proficiency with Access or Excel (Pivot Tables and VLOOKUP).
Microsoft Word, Outlook and SharePoint preferred.
Data reporting skills preferred.
Ability to manage multiple priorities and tight deadlines with high quality results.
Excellent communication skills, both written and verbal.
Ability to quickly learn new and complex tasks and concepts.
Inquisitive nature; capable of thinking critically and challenging assumptions.
Comfortable working independently and with a team.

Competencies:
Learning and applying quickly
Organizing
Priority Setting
Problem Solving
Interpersonal Savvy

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 20 - 30 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 Group .

About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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 email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for 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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