Quality Review and Audit Lead Analyst - Express Scripts - Remote

The Quality Review and Audit Lead Analyst supports Quality Control, Audit, and testing initiatives across client implementations, benefit changes, and ongoing business activities. This role focuses on executing defined test plans, validating benefit configuration and data accuracy, documenting defects, and supporting testing timelines in alignment with established methodologies and guidance.
 

Applying analytical thinking, attention to detail, and foundational subject matter knowledge, the Analyst helps identify issues, validate expected outcomes, and support accurate delivery of client and regulatory requirements. Working in a collaborative, fast-paced environment, the Analyst partners with implementation, account, operations, and product teams—under the direction of Advisors and Senior Advisors—to ensure test execution aligns with defined requirements and business objectives.
 

The role also contributes to operational readiness and continuous improvement by following established procedures, documenting findings, and by participating in lessons learned and process improvement efforts. The Analyst supports multiple Lines of Business, including HealthPlan, Medicare, Medicaid, Exchange, Commercial, DoD, and Cigna, and may participate in client-facing activities with appropriate oversight while continuing to build expertise across testing methodologies, business processes, and lines of business.
 

Key Responsibilities:

Testing Execution & Support

• Execute assigned testing activities for implementations, benefit changes, and business initiatives following defined test plans and procedures
• Perform data validation and test case execution to confirm accuracy, completeness, and alignment with expected setup
• Support test preparation activities, including test data creation and validation
• Assist in maintaining testing schedules and meeting expected completion dates
   

Issue Identification & Documentation

• Identify and document testing defects, discrepancies, and observations clearly and accurately
• Track issues and support escalation to Advisors or project leads as needed
• Retest fixes and validate resolutions to confirm expected outcomes
• Maintain detailed documentation of testing results and findings
   

Process Adherence & Continuous Improvement

• Follow established testing processes, quality controls, and documentation standards
• Participate in lessons learned discussions and contribute suggestions for process enhancements
• Support updates to testing documentation, job aids, and reference materials
• Assist with pilot initiatives, special projects, and ad hoc testing efforts as assigned
   

Collaboration & Professional Development

• Participate in project meetings, team discussions, and working sessions
• Collaborate with peers and cross-functional partners to support testing deliverables
• Actively build knowledge of benefits, configuration, and testing methodologies
• Seek and incorporate feedback to support skill development and readiness for increased responsibility
   

Required Qualifications:

• Bachelor’s degree required, with 1+ years of experience in operations, benefits/clinical, claims processing, testing, quality assurance, audit, or a related role preferred  – or–  5+ years of related experience
• Basic knowledge of healthcare benefits and/or claims processing preferred
• Clinical, pharmacy, or healthcare-related background preferred
• Ability to follow testing instructions, document findings, and meet assigned deadlines
• Willingness to learn multiple Lines of Business, including HealthPlan, Medicare, Medicaid, Exchange, Commercial, DoD, and Cigna
• Proficiency in Microsoft Excel, Word, Outlook, PowerPoint, 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 68,700 - 114,500 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.