Operating Effectiveness Analyst

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Skills you'll use

What you'll do

• ISO Audit & Compliance
• Plan and execute internal audits aligned to ISO 9001:2015 (Clause 9.2) and ISO 9001:2026
• Conduct process audits across the end-to-end claims lifecycle (intake → adjudication → payment → appeals)
• Perform gap assessments to evaluate compliance against QMS standards
• Ensure robust audit documentation, evidence validation, and traceability
• Claims Process Oversight
• Assess claims accuracy, turnaround time (TAT), and policy adherence
• Audit critical processes, including:
• Claims adjudication
• Eligibility & enrolment validation

Who can apply

• 5–10 years of relevant experience in:
• Healthcare BPO / US/International healthcare claims operations
• Quality, audit, or compliance roles
• Functional Expertise
• Strong understanding of:
• US / International healthcare claims lifecycle
• ISO 9001:2026 Quality Management System framework
• Demonstrated experience in:
• Internal and process audits
• CAPA management and closure

About Cigna

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