Audit Operations Lead – Compliance & Process Improvement

Cigna; Connecticut; Hybrid; USD 63,000 - 104,000; Full time

Benefits offered by this job

Medical

Vision

Dental

Well-being program

401(k)

Life insurance

Tuition reimbursement

PTO 18 days

Paid holidays

Leaves of absence

Job summary

The Cigna Group, through Evernorth Health Services, is hiring for an audit/compliance coordination role focused on CMS, NCQA, URAC, and related audits. The position emphasizes cross-team collaboration, documentation, and process improvement. Salary ranges and bonus eligibility reflect experience and geographic factors.

Remote/hybrid work options may apply, with an anticipated annual bonus plan. Join a large healthcare group committed to quality, compliance, and patient-centric services.

Qualifications

• High school diploma required; bachelor's degree preferred.
• 5+ years of experience in client/customer support, healthcare operations, audit, compliance, project coordination, or related area.
• Experience coordinating complex, time-sensitive work across multiple teams.
• Strong communication, organization, problem-solving, adaptability, and time-management skills.
• Knowledge of prior authorization, post-service processes, reporting, or relevant eviCore systems.

Responsibilities

• Audit responsibilities may include: CMS Program and Mock Audits
• Delegation and Data Validation Audits
• NCQA and URAC Audits
• Internal audit findings and remediation
• Other compliance, regulatory, or operational initiatives
• Manage audit activities from intake through execution, remediation, validation, and closure.
• Clarify requirements, timelines, dependencies, and deliverables.
• Translate complex or incomplete requests into actionable next steps.
• Research unfamiliar issues and engage subject matter experts as needed.
• Coordinate activities across multiple teams and stakeholders.
• Facilitate audit preparation, meetings, requirements discussions, and follow-up.
• Maintain documentation and communicate status, risks, and next steps.
• Identify and upscale risks while recommending solutions.
• Improve SOPs, workflows, tools, and audit processes.

Skills

Communication skills

Organization

Problem solving

Adaptability

Time management

eviCore systems

Education

High school diploma

Bachelor's degree preferred

Job description

The Cigna Group, through Evernorth Health Services, is hiring for an audit/compliance coordination role focused on CMS, NCQA, URAC, and related audits. The position emphasizes cross-team collaboration, documentation, and process improvement. Salary ranges and bonus eligibility reflect experience and geographic factors.

Remote/hybrid work options may apply, with an anticipated annual bonus plan. Join a large healthcare group committed to quality, compliance, and patient-centric services.