Quality Review and Audit Advisor - Express Scripts - Remote

Cigna Healthcare•St. Louis, MO

21h•Remote

About The Position

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.

Requirements

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
Proven ability to work autonomously, manage competing priorities, and meet critical deadlines
Proficiency in Microsoft tools including advanced Excel, PowerPoint, Word, Outlook, and SharePoint
Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Nice To Haves

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

Responsibilities

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
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
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
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