Audit Operations Lead - Evernorth - Remote

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

Key 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.

Minimum Requirements

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

Preferred Qualifications

• Healthcare, regulatory, accreditation, client, or internal audit experience.
• Experience developing or improving SOPs, workflows, or process documentation.
• Knowledge of prior authorization, post-service processes, reporting, or relevant eviCore systems.

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 annual salary of 62,600 - 104,300 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

Benefits

• medical
• vision
• dental
• well-being and behavioral health programs
• 401(k)
• company paid life insurance
• tuition reimbursement
• a minimum of 18 days of paid time off per year
• paid holidays
• leaves of absence

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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 need a reasonable accommodation to complete the online application process, please email [e-mail] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.