The Audit Operations Lead provides advanced support for complex client, regulatory, accreditation, and internal audits. This role is ideal for someone who can navigate ambiguity, solve problems, coordinate across teams, and take ownership of work through resolution.

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 escalate 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.

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. 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. For more details on our employee benefits programs, click here.

About Evernorth Health Services

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 seeyourself@thecignagroup.com 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.

High school diploma required; bachelor's degree preferred. 5+ years in customer support, healthcare operations, audit, compliance, or project coordination. Experience coordinating complex work across teams. Strong communication and problem-solving skills.

Key Responsibilities

• coordinating audits
• managing stakeholders
• improving processes

Skills & Tools

eviCore systems

Job Details

• Category: Business Operations
• Seniority: Senior Level
• Commitment: Full Time
• Workplace: Remote — Connecticut or Texas
• Salary: USD 62,600 – 104,300 / year
• Languages: English

Benefits

• Generous paid time off
• Tuition reimbursement
• Retirement plan

About The Cigna Group

A global health service company creating pharmacy, care, and benefit solutions to improve health and increase vitality. — Industry: Healthcare