Job description

As a Quality Review and Audit Advisor on the Operations Testing team, you’re responsible for client and auditors' testing needs and requirements on behalf of PBM Operations. Your team is responsible for relationship building, testing/validating, and communicating results to internal/external business partners for new and existing clients.

The Quality Review and Audit Advisor supports and maintains the quality assurance functions within the team. The Advisor will also manage new and existing client testing needs/requirements, creating end-to-end test scenarios and, executing test plans when business needs arise. This person will be expected to monitor the daily status of client implementations and assist in collaboration efforts with internal partners to obtain necessary information. They will execute testing project plans and communicate results in a client/vendor-facing environment when applicable.

RESPONSIBILITIES:
Manage new and existing client testing to validate benefit setup based on clients’ intent and expectations. Troubleshoot and resolve issues promptly to meet effective dates.

Execute a project plan and communicate results in a client/vendor-facing environment when applicable.

Considerable cross-functional communication to effectively monitor the daily status of client implementations and assist in collaboration efforts with internal partners. Attend client meetings and create custom test cases when applicable.

Relationship building and daily partnership with Implementation, CBA, Account Management, and Eligibility.

Create and maintain client-specific documentation related to benefit validation.

Provide on-the-job training and mentoring to less experienced team members to improve their understanding and skills. Work collaboratively with other team members to ensure that best practices are shared.

Assist with projects as assigned.

QUALIFICATIONS

High School Diploma or GED; Bachelor’s degree preferred

3+ years' experience using advanced Excel features (V-lookup, pivot tables, macros) is required

3+ years' leading/managing projects from start to finish is required

Strong working knowledge of claim adjudication and/or retail systems and requirements preferred

Background in Healthcare or Pharmacy is a plus

Knowledge of writing and running queries in SQL is a plus

Excellent verbal and written communication skills

Solid organizational and demonstrated skills in prioritizing workload is a must

Strong interpersonal and collaboration skills; Effectively able to work well independently and within a team environment

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 72,600 - 121,000 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.

We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, 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, visit Life at Cigna Group .

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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

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.

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