Role Description
This role is responsible for driving ISO 9001-compliant internal audit practices across healthcare claims operations at CHSI Bangalore. The incumbent will ensure adherence to Quality Management Systems (QMS), strengthen operational controls, and enable a culture of continuous improvement, compliance, and audit readiness.
Key Responsibilities
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
- Denials & appeals management
- Identify process inefficiencies, control gaps, and operational risks
CAPA & Continuous Improvement
- Drive Corrective and Preventive Actions (CAPA) for audit findings
- Track closure of findings with quantifiable outcomes and timelines
- Partner with operations to standardize processes and drive quality improvements
Stakeholder Engagement
- Collaborate with:
- Operations leadership
- Quality assurance teams
- Training and transition stakeholders
- Support external certification audits and regulatory reviews
- Develop audit reports, insights, and executive-ready summaries
Governance & Reporting
- Manage audit calendars, trackers, and compliance dashboards
- Publish insights on defect trends, risk indicators, and audit outcomes
- Support Management Review Meetings (MRMs) and governance forums
Candidate Profile
Education & Certifications
- Graduate (mandatory)
- Preferred certifications:
- ISO 9001 Internal Auditor / Lead Auditor
- Six Sigma Green Belt (or equivalent)
Experience
- 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
- Compliance monitoring
Core Skills
- Audit planning and execution
- Root cause analysis and problem-solving
- Stakeholder management and influencing
- Documentation and reporting excellence
- Data analysis and dashboarding (Excel / reporting tools)
Behavioural Competencies
- High attention to detail and professional integrity
- Strong analytical and structured problem-solving mindset
- Ability to challenge and influence constructively
- Effective communication across cross-functional teams
About The Cigna Group
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.Skills Required
- Graduate (mandatory)
- 5-10 years relevant experience in healthcare BPO or healthcare claims operations
- Experience in quality, internal audit, or compliance roles
- Strong understanding of US / International healthcare claims lifecycle
- Experience planning and executing internal and process audits
- Experience driving CAPA management and closure
- Experience with compliance monitoring and gap assessments
- Knowledge of ISO 9001:2015/2026 QMS (ISO audit framework)
- ISO 9001 Internal Auditor / Lead Auditor certification
- Six Sigma Green Belt (or equivalent)
- Audit documentation, evidence validation, and traceability expertise
- Data analysis and dashboarding skills (Excel / reporting tools)
- Strong stakeholder management and communication skills
- Root cause analysis and structured problem-solving capability
Cigna Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Cigna and has not been reviewed or approved by Cigna.
-
Strong & Reliable Incentives — Strong bonus outcomes are frequently highlighted, with annual bonuses described as really good alongside above-average salary levels. Stock or long-term incentive elements are also noted as part of the overall package in some roles.
-
Leave & Time Off Breadth — Time-off benefits are portrayed as a meaningful part of total rewards, including generous PTO and flexibility that can enhance the perceived value of compensation. Flexible work-from-home arrangements are repeatedly linked with satisfaction about the overall package.
-
Healthcare Strength — Health coverage is described as broad in design, with preventive care often covered at no charge in-network and options like virtual care and wellness incentives. A large provider network and strong digital tools are positioned as practical advantages when using benefits.
Cigna Insights
What We Do
At Cigna, we're more than a health insurance company. We are your partner in total health and wellness. And we’re here for you 24/7 – caring for your body and mind. As a global health service company, Cigna's mission is to improve the health, well-being, and peace of mind of those we serve by making health care simple, affordable, and predictable. Our values are the core of our culture. Our values guide how all 74,000 of us around the world work together, serve our customers, patients, clients, communities, and deliver on our mission.
