Quality Review and Audit Advisor - Express Scripts - Remote

The Quality Review and Audit Advisor provides expert execution for complex, high impact Quality Assurance and Audit initiatives. This role is responsible for planning, leading, and delivering largescale and cross-functional testing efforts that ensure accurate benefit, clinical, and pricing configuration while supporting successful client implementations and operational changes.
 

Operating in a fast paced, highly collaborative environment, the Advisor exercises sound judgment, foresight, and creativity to develop testing strategies, evaluate issues, and drive resolution efforts that directly impact clients, members, providers, and vendor partners. The role partners closely with implementation, account management, operations, product, and regulatory teams—and works directly with clients as needed—to ensure thorough test planning, execution, validation, and clear communication of results.
 

A core focus of the position is client centric benefit and clinical testing, validation of pricing and configuration accuracy, and deep understanding of client setup and operational processes. The Advisor supports regulatory and operational audits, contributes to procedural and control enhancements, and ensures appropriate documentation, milestone management, and communication across initiatives. Through this work, the role enables accurate benefit setup and mitigates downstream risk for clients, internal partners, and members.
 

The Quality Review and Audit Advisor also plays a key role in department level continuous improvement by identifying opportunities for process rigor, implementing enhancements, and supporting operational excellence. The position supports multiple Lines of Business—including HealthPlan, Medicare, Medicaid, Exchange, Commercial, DoD, and Cigna—and is considered client facing, with expertise in benefits, clinical configuration, and pricing setup.
 

Upon mastery of key testing initiatives, the Advisor is recognized as a subject matter expert and provides thought leadership within Quality Review and Audit, collaborating across the broader enterprise to support complex business objectives and drive meaningful quality outcomes.

Key Responsibilities:

Testing & Implementation Leadership

• Lead or co-lead testing activities for new client implementations, benefit/clinical/pricing changes, and existing business initiatives
• Partner with clients and Account, Implementation, Operations, and Product teams to understand business intent and translate requirements into comprehensive testing scenarios
• Develop, validate, and execute detailed test plans aligned to client expectations and delivery timelines
• Create, review, and validate testing data to ensure quality, completeness, and accuracy
• Ensure testing activities are completed within established deadlines

Issue & Risk Management

• Identify, document, track, and escalate defects and issues to appropriate teams
• Partner with stakeholders to support issue resolution and drive optimal outcomes
• Communicate testing status, risks, and challenges to Operations Testing leadership
• Produce and maintain testing status and progress reporting

Process Improvement & Quality Controls

• Develop and maintain reusable quality controls, testing procedures, and documentation to support implementations and ongoing business changes
• Support lessons-learned activities and provide actionable recommendations to enhance processes
• Identify opportunities to improve testing tools, workflows, and cross-functional coordination
• Support pilot initiatives and strategic department projects that enhance efficiency and client satisfaction

Collaboration, Communication & Team Development

• Participate in project status meetings, client calls, and ad hoc working sessions
• Contribute to training, documentation, and knowledge sharing activities
• Mentor and support less experienced team members
• Promote team effectiveness through collaboration, best practice sharing, and engagement in special projects

Qualifications:

• Bachelor’s degree required and 3+ years of experience in operations, benefits/clinical, claims processing, testing, quality assurance, audit, or a related role required – or –  6+ years of related experience
• Experience supporting HealthPlan, Medicare, Medicaid, Exchange, Commercial, DoD, and/or Cigna Lines of Business
• Clinical, pharmacy, or healthcare-related background preferred
• Project Management Certification or skillset is preferred
• Strong business acumen with the ability to quickly learn new business domains and processes
• Proven ability to work autonomously, manage competing priorities, and meet critical deadlines
• Proficiency in Microsoft tools including advanced Excel, PowerPoint, Word, Outlook, and SharePoint

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 78,800 - 131,300 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.