Audit Operations Lead – Evernorth – Remote

520 eviCore healthcare MSI, LLC; Tennessee; Hybrid; USD 63,000 - 104,000; Full time

Benefits offered by this job

Health, vision, dental coverage

401(k) with company match

Tuition reimbursement

Paid time off and holidays

Job summary

The Cigna Group is seeking a Compliance & Audit professional to lead CMS programs and audits, coordinate cross-functional remediation, and drive ongoing process improvements. This role emphasizes strong communication and cross-team collaboration within healthcare operations and regulatory frameworks.

Ideal candidates will have 5+ years in healthcare operations, audits, or compliance, plus experience in coordinating time-sensitive work and developing or improving SOPs and workflows.

Qualifications

• 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.

Responsibilities

• 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 escape risks while recommending solutions.
• Improve SOPs, workflows, tools, and audit processes.

Skills

Strong communication

Organization

Problem-solving

Adaptability

Time-management

Education

High school diploma

Bachelor’s degree

Tools

eviCore systems

Job description

Key Responsibilities

• 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 escape 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.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health.

For more details on our employee benefits programs.

Benefits

• 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), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and 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.

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.