The US Individual (IFP) Quality Review and Audit Senior Representative is responsible for daily auditing of those interacting in a multi-functioning capacity with our individual customer. This individual would be responsible for quality assurance and audit functions for internal and external activities as well as responsibility for accurate data entry that supports collection and reporting. The Quality Review and Audit Senior Representative may assist project components in the evaluation and/or development of new procedures/processes to mitigate compliance risk, address customer issues and improve on the overall customer experience as result of audit data.

Primary interfaces include: Internal audit and Quality Assurance team, external vendor partners and business partners

Core Responsibilities:

• Conducting quality review daily through call monitoring and processing system reviews to ensure appropriate processes are met within individual products
• Listening or Inspecting-Auditing to/assess work randomly to ensure established standards are being met by vendors
• Following auditing and quality controls for scoring audits and maintaining audit records
• Ensuring vendor and internal adherence to the appropriate compliance standards and regulatory guidelines
• Analyzing data results using tools such as Excel or MS Access
• Working with internal teams to find solutions for quality administration of IFP or DTC business
• Identifying customer needs and solutions
• Identifying and communicating gaps in processes
• May assist in projects for processes
• Creating strong working relationships with internal teams and matrix partners
• Negotiating and presenting results to internal teams and matrix partners as needed
  

Minimum Qualifications:

• 2+ years or more of related experience required (Benefits, Eligibility, Claims, Call, Sales, Audit)
• Experience with IFP Segment highly desired
• Knowledge of Affordable Care Act and the Federal Exchange
• Ability to function in a fast-paced environment and prioritize multiple tasks under strict deadlines
• Proficient in Outlook, Word, and Excel
• Demonstrates ability to drive results through independent and team goal setting
• Competent oral and written communication skills
• Flexibility to change course based on business needs
• Bilingual highly desired
• Some travel may be required (10%)

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 Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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.