Reference Data Management Quality Auditor – Provider Data Quality

The job profile for this position is Quality Review and Audit Lead Representative, which is a Band 2 Professional Career Track Role.

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Job Title: Reference Data Management Quality Auditor – Provider Data Quality

Location: Bangalore

Band: 2

Reports To: Reference Data Management Senior Supervisor

Role Summary:

The Reference Data Management vertical is a critical piece of the Business Excellence organization in International Health Delivery Services (IHDS). Under the leadership of the Reference Data Management Senior Manager, this vertical focuses on establishing the right operating processes, controls, standardization and strategic roadmaps pertaining to critical and prioritized reference data in IH’s primary operating systems/platforms. One of the key datasets in scope will be Provider Data Management, focusing on international Provider data within Cigna International Markets.

The Quality Auditor will ensure the integrity and accuracy of provider data across PRM and PAS systems. This role focuses on auditing data cleansing activities, validating bulk updates, and confirming the quality of changes to provider data elements. The auditor 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, ensuring adherence to established standards and guidelines.
• 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 any changes to provider data elements (e.g., Critical Data Elements such as PRM ID, bank details, contact info) meet quality and compliance requirements.
• Root Cause Analysis: Investigate discrepancies or recurring issues 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.

Required Skills & Experience

• 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 (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 capability to perform root cause analysis and recommend solutions.

Preferred Qualifications

• Experience with bulk data processing tools and automation solutions.
• Knowledge of regulatory compliance related to provider data.
• Familiarity with audit frameworks and continuous improvement methodologies.

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