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
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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.
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