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 large scale 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 Health Plan, 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

** Skills, Attributes & Core Competencies*
* ** Core Competencies*
* + Demonstrates Cigna values, including teamwork, accountability, and an enterprise mindset

+ Strong critical-thinking, problem-solving and analytical skills with proven ability to manage multiple concurrent initiatives

+ Ability to coordinate cross-functional resources to resolve complex issues and deliver results

+ Comfortable operating in a dynamic environment with minimal supervision

** Professional Attributes*
* + Strong organizational, prioritization, and time management skills

+ Excellent verbal and written communication skills, including the ability to clearly articulate status, risks, and recommendations to diverse audiences

+ Demonstrated initiative, adaptability, and resilience under pressure

+ Willingness to work flexible schedules during peak or critical delivery periods

** Qualifications*
* ** Required Qualifications*
* + Bachelor's degree required and 3+ years of experience in operations, benefits/clinical, claims…