Quality Review/Audit Sr Assoc','18001757','!*!Role Summary:
This position is responsible for conducting audits to ensure compliance and accuracy of the assigned business area. This will include assisting in the development of audit tools and recommending changes in processing procedures. As a member of the Customer & Client Service Experience (CCSE) Ops Internal Monitoring Team, the incumbent will have the ability and be expected to drive change, and positively impact the accuracy and efficiency of Cigna Healthspring’s operations by recommending actions that address error trends and root-causes of errors found during quality audits.
Complete assigned audits in a timely manner
Follow up and respond to inquiries from the auditee regarding audit work performed
Identify and report error trends to Management
Work with management in developing appropriate remediation steps to address audit findings and error trends
Train other auditors and create job aids and other related material for the CCSE Ops Internal Monitoring department
Develop subject matter expertise in areas audited and become resource for the team
Ability to meet production demands and maintain a high level of quality. This may include occasional overtime, especially during the peak seasons
Supports and drives process improvement to further enhance service outcomes; opportunities for streamlining processes and procedures, reducing rework
Supports and reinforces updated and/or new information; SOPs, tools, system enhancements, workflows, etc.
Knowledge of Part C Claims processing, Medicare, Medicaid, and IPA.
Knowledge of the QNXT claims processing platform preferred.
Working knowledge of Microsoft Word & Access, SharePoint, and Lync, with intermediate proficiency level of Excel.
Experience in quality review/auditing
Skilled in analyzing quality results
Proven confidence in the usage and application of all tools, workflows, and processes in current role
Minimum 3 years’ experience in a managed care or related field
Possess an understanding of operational and compliance auditing
Exceptional verbal and written communication skills
Work independently and with the team with minimal oversight and supervision
Ability to meet strict timelines
Strong interpersonal skills to work with many different personalities and styles
Capable of explaining complex issues in a concise manner
Detail oriented','Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. Need an accommodation? Email: SeeYourself@cigna.com','United States-Tennessee-Nashville','','500 Great Circle Road','','Nashville','37228','Bus Ops--Quality Assur/Audit','Yes','Yes','Full-time','Day Job','Regular','Standard','Individual Contributor','','Mar 13, 2018','Quality Review/Audit Sr Assoc
Cigna works with employers and organizations around the world helping employees stay healthy and on the job. We work closely with brokers and consultants to develop innovative programs, help individuals and families improve their health, well-being and sense of security—and lower their medical costs. And, Cigna provides access to a global network of local physicians and hospitals—as well as 24/7/365 live customer service.