Quality Review and Audit Senior Representative (Remote)

Quality Review and Audit Senior Representative (Remote) (Finance) Quality Review and Audit Senior Representative (Remote) (Finance) The Provider Data Senior Representative is responsible for ensuring the accuracy and integrity of provider data by verifying, updating, and loading information across multiple systems. This role also supports the execution of provider agreements and serves as a key point of contact for internal and external inquiries related to provider data. Key Responsibilities:

• Load and maintain provider data across multiple internal systems.
• Verify provider data on contracts and screening forms for accuracy and completeness.
• Ensure demographic and fee schedule information is correctly reflected in contracts.
• Send updated contracts to providers when demographic changes require contract modifications.
• Load delegated clinic rosters into applicable systems.
• Respond to internal and external inquiries via email or phone in a timely and professional manner.

Minimum Qualifications:

• Strong communication skills, both verbal and written, with a customer-centric approach.
• Excellent analytical and problem-solving abilities; self-directed and proactive.
• Proficiency in navigating computerized data entry systems and relevant tracking applications.
• Familiarity with Microsoft Office Suite (Word, Excel, Outlook).
• Ability to work effectively in a fast-paced, matrixed team environment.
• Strong interpersonal skills with a proven ability to build and maintain relationships.
• Demonstrated decision-making, negotiation, and financial acumen.
• Experience working with provider contracts and understanding of contract language is preferred.

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 58,400 - 97,400 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. We want you to be healthy, balanced, and feel secure. That's why 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) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group . 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 require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response. 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. #J-18808-Ljbffr Salary: USD 58400 - 97400 per year Experience: 5 years required