Reference Data Management Quality Auditor - Provider Data Quality

Job Description

Role Overview:You will be working as a Quality Auditor in the Reference Data Management vertical of International Health Delivery Services. Your main responsibility will be to ensure the integrity and accuracy of provider data across PRM and PAS systems. You will work closely with Provider Data Quality (PDQ) teams and other stakeholders to maintain compliance with business rules and regulatory standards.Key Responsibilities:- Audit Data Cleansing Activities: Review and validate data cleansing processes for provider records to ensure adherence to established standards.- Bulk Update Quality Checks: Verify the accuracy and completeness of mass uploads or updates to provider data in PRM and PAS.- Change Validation: Confirm that changes to provider data elements meet quality and compliance requirements.- Root Cause Analysis: Investigate discrepancies in provider data and recommend corrective actions.- Reporting & Documentation: Maintain detailed audit logs, prepare reports on findings, and present trends or risks to leadership.- Process Improvement: Identify gaps in data management processes and propose enhancements to reduce errors and improve efficiency.- Compliance Assurance: Ensure provider data aligns with regulatory requirements and internal policies.Qualification Required:- Strong understanding of provider data management systems (PRM, PAS, Globalcare, Diamond, Actisure).- Experience in data quality auditing, data cleansing, and validation processes.- Proficiency in Excel with advanced formulas and familiarity with reporting tools like Tableau.- Ability to interpret complex business rules and apply them consistently.- Excellent attention to detail and organizational skills.- Strong communication skills for stakeholder engagement and reporting.- Minimum 2 years of experience in health insurance or international healthcare provider data management.- Analytical mindset with the capability to perform root cause analysis and recommend solutions.Additional Details:About The Cigna Group:Cigna Healthcare, a division of The Cigna Group, advocates for better health through every stage of life. They guide customers through the healthcare system, empowering them with the information and insight needed to make the best choices for improving health and vitality. Join The Cigna Group in driving growth and improving lives. Role Overview:You will be working as a Quality Auditor in the Reference Data Management vertical of International Health Delivery Services. Your main responsibility will be to ensure the integrity and accuracy of provider data across PRM and PAS systems. You will work closely with Provider Data Quality (PDQ) teams and other stakeholders to maintain compliance with business rules and regulatory standards.Key Responsibilities:- Audit Data Cleansing Activities: Review and validate data cleansing processes for provider records to ensure adherence to established standards.- Bulk Update Quality Checks: Verify the accuracy and completeness of mass uploads or updates to provider data in PRM and PAS.- Change Validation: Confirm that changes to provider data elements meet quality and compliance requirements.- Root Cause Analysis: Investigate discrepancies in provider data and recommend corrective actions.- Reporting & Documentation: Maintain detailed audit logs, prepare reports on findings, and present trends or risks to leadership.- Process Improvement: Identify gaps in data management processes and propose enhancements to reduce errors and improve efficiency.- Compliance Assurance: Ensure provider data aligns with regulatory requirements and internal policies.Qualification Required:- Strong understanding of provider data management systems (PRM, PAS, Globalcare, Diamond, Actisure).- Experience in data quality auditing, data cleansing, and validation processes.- Proficiency in Excel with advanced formulas and familiarity with reporting tools like Tableau.- Ability to interpret complex business rules and apply them consistently.- Excellent attention to detail and organizational skills.- Strong communication skills for stakeholder engagement and reporting.- Minimum 2 years of experience in health insurance or international healthcare provider data management.- Analytical mindset with the capability to perform root cause analysis and recommend solutions.Additional Details:About The Cigna Group:Cigna Healthcare, a division of The Cigna Group, advocates for better health through every stage of life. They guide customers through the healthcare system, empowering them with the information and insight needed to make the best choices for improving health and vitality. Join The Cigna Group in driving growth and improving lives.

Keyskills :
Data CleansingExcelTableauRoot Cause AnalysisCompliance AssuranceStakeholder EngagementReportingProvider Data Management