Quality Review And Audit Lead Representative - Remote

As a Quality Review and Audit Lead Representative you will audit claims for accuracy and compliance with an opportunity for growth and development across multiple audit areas including pre-disbursement. Our team provides feedback and helps with trend improvement and coaching opportunities for the claims organization. In this role you will have an opportunity to influence the customer journey. Identifies and recommends changes to improvements in department processing and procedures, and assists in the development of audit guidelines. May provide guidance, coaching, and direction to more junior members of the team in Quality Review and Audit.
How you’ll make an impact:
Be accountable for providing auditing feedback by utilizing KnowledgeXchange, Checklists, and job aids to validate accuracy of audits and proper handling per Cigna policy and guidelines
Collaborate with supervisor to lead change with our business partners and assist in the development of audit guidelines
Act as subject matter expert in your scope
Participate in MOS with leadership to identify growth opportunities
spend 90% of your day auditing resource information and ensuring claims are paid accurately
Ensure production, quality and attendance metrics are met
Effectively work in a diverse and virtual environment
What you’ll need:
High School Diploma or G.E.D.
2+ years claims processing experience using Facets/Prepay.
Complex Claim experience (examples being stop loss and level of care) highly preferred
Problem solving skills; utilization of technical skills and resources to ensure accuracy
Accountability in critical thinking and decision making outcomes
Strong communication skills, both verbal and written; ability to adapt communication to the individual or audience
Process improvement skills; ability to assess trends, processes, and barriers to drive positive outcomes for claim resolutions
We expect the work schedule to primarily fall within Monday – Friday normal business hours within your time zone.
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 22 - 34 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: [email protected] for support. Do not email [email protected] 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.