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 qualified 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.

📌 Operating Effectiveness Analyst (Bengaluru)
🏢 Cigna Healthcare
📍 Bengaluru