Role DescriptionThis 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 & CompliancePlan and execute internal audits aligned to ISO 9001:2015 (Clause 9.2) and ISO 9001:2026Conduct process audits across the end-to-end claims lifecycle (intake → adjudication → payment → appeals)Perform gap assessments to evaluate compliance against QMS standardsEnsure robust audit documentation, evidence validation, and traceabilityClaims Process OversightAssess claims accuracy, turnaround time (TAT), and policy adherenceAudit critical processes, including:Claims adjudicationEligibility & enrolment validationDenials & appeals managementIdentify process inefficiencies, control gaps, and operational risks CAPA & Continuous ImprovementDrive Corrective and Preventive Actions (CAPA) for audit findingsTrack closure of findings with quantifiable outcomes and timelinesPartner with operations to standardize processes and drive quality improvements Stakeholder EngagementCollaborate with:Operations leadershipQuality assurance teamsTraining and transition stakeholdersSupport external certification audits and regulatory reviewsDevelop audit reports, insights, and executive-ready summaries Governance & ReportingManage audit calendars, trackers, and compliance dashboardsPublish insights on defect trends, risk indicators, and audit outcomesSupport Management Review Meetings (MRMs) and governance forumsCandidate ProfileEducation & CertificationsGraduate (mandatory)Preferred certifications:ISO 9001 Internal Auditor / Lead AuditorSix Sigma Green Belt (or equivalent) Experience5–10 years of relevant experience in:Healthcare BPO / US/International healthcare claims operationsQuality, audit, or compliance roles Functional ExpertiseStrong understanding of:US / International healthcare claims lifecycleISO 9001:2026 Quality Management System frameworkDemonstrated experience in:Internal and process auditsCAPA management and closureCompliance monitoring Core SkillsAudit planning and executionRoot cause analysis and problem-solvingStakeholder management and influencingDocumentation and reporting excellenceData analysis and dashboarding (Excel / reporting tools) Behavioural CompetenciesHigh attention to detail and professional integrityStrong analytical and structured problem-solving mindsetAbility to challenge and influence constructivelyEffective communication across cross-functional teamsAbout 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.