Quality Review and Audit Analyst, Individual Dental Operations - Cigna Healthcare - Remote

Summary The Quality Review and Audit Analyst conducts quality reviews and audits of customer interactions, operational transactions, and supporting system activity within Individual Dental Operations. The role evaluates work against established procedures, quality standards, business requirements, and applicable regulatory expectations. The Analyst accurately scores reviews, maintains audit documentation, records audit results, and communicates identified errors or process concerns. The position applies established techniques and procedures to routine and moderately complex assignments and escalates questions requiring additional technical or business interpretation. This role contributes to quality reporting, calibration, process improvement, and customer experience efforts by identifying issues and providing reliable audit information to Quality Assurance leadership and business partners. Core Accountabilities and Responsibilities Quality Review and Audit Execution Conduct assigned quality reviews through call monitoring, transaction review, claim review, or examination of relevant operational systems and records. Evaluate work against established procedures, audit guidelines, quality standards, and applicable business requirements. Apply approved scoring criteria and quality controls consistently. Complete routine and moderately complex audits within established productivity, accuracy, and timeliness expectations. Record audit results accurately in designated systems, trackers, or reporting tools. Maintain complete documentation supporting audit scores, identified errors, and review outcomes. Identify questions or unusual circumstances and escalate them to a Senior Analyst, Lead Analyst, or Quality Assurance leader. Protect customer and business information in accordance with applicable privacy, security, and records-management requirements. Findings and Issue Identification Identify and document errors, procedural gaps, and instances in which established quality requirements were not met. Provide clear examples and supporting facts when communicating audit findings. Recognize recurring observations within assigned work and share potential trends with the Senior Analyst, Lead Analyst, or supervisor. Communicate system problems or technical barriers that affect audit completion or accuracy. Participate in discussions regarding audit findings and provide supporting case information when requested. Avoid making unsupported conclusions beyond the evidence available in the audit record. Escalate potential compliance or customer-impacting concerns promptly through established channels. Audit Data and Reporting Support Enter audit information accurately and completely to support quality-data collection and reporting. Review entered data for completeness and correct identified errors. Assist with the preparation and distribution of standard audit reports and summaries. Use Microsoft Excel and other approved tools to organize audit information and support basic trend identification. Provide audit records, examples, or supporting documentation needed for quality reporting and analysis. Assist with questionnaires, selected case validation, error responses, or evidence collection for internal, external, or third-party reviews. Follow established data definitions and reporting procedures to promote reliable quality information. The source description specifically assigns the Analyst responsibility for accurate audit-data entry, initial reporting and analysis, report distribution, and support for third-party audits.  Calibration and Knowledge Development Participate in calibration sessions to strengthen understanding and consistent application of audit standards. Bring appropriate cases or questions forward for calibration or technical review. Incorporate calibration decisions and feedback into subsequent audit work. Maintain current knowledge of applicable procedures, audit guidance, products, systems, and business