Quality Review and Audit Advisor - Express Scripts - Hybrid

POSITION SUMMARY

The Quality Review and Audit Advisor is responsible for complex and large-scale/cross-functional testing projects and initiatives including but not limited to end-to-end benefit testing and implementation support management with a strong emphasis on process and client setup knowledge and internal and external communications.

The role exists within a fast-paced and dynamic team whose focus is to collaborate and empower each other to deliver complex implementations benefit changes and enterprise projects on time. The Quality Review and Audit Advisor will collaborate with various business operational stakeholders and Centene to ensure an adequate test plan is in place and executed to test and validate client testing requirements. The team is responsible for confirming accurate benefit setup through testing to best position Centene its members and those who support them for success.

The Advisor will drive internal and enterprise-focused projects to deliver continuous improvement by collaborating with stakeholders managing and delivering on critical milestones and implementing changes with needed documentation and communication.

This role supports Centene Medicare Medicaid and Exchange (HIM) lines of business with an emphasis on benefits clinical and network configuration and is client-facing.

Essential Responsibilities Skills and Attributes For Success

• Lead or co-lead implementation testing of new Centene implementations and existing business changes and initiatives

• Work directly with Centene PMO Account Teams Client Service Teams Operations and Product partners to understand client setup/intent testing scenarios meet client expectations deadlines impacts/changes to ensure delivery of client contractual testing requirements drive overall client satisfaction.

• Create review and confirm testing data for quality and accuracy

• Ensure the execution of the business testing is completed within the expected completion date.

• Communicate status and risk to Centene Benefit Validation and Testing leadership.

• Ensure defects/issues are documented tracked and escalated to appropriate teams. Support solutions to issues/defects to drive optimal outcomes.

• Report on business testing status.

• Attend and participate in project status client calls and ad hoc meetings.

• Develop ongoing quality controls and testing procedures that can be reused for projects implementations or maintenance of business changes.

• Support lessons learned. Provide recommendations to improve processes and contribute to ongoing process improvements within the role.

• Support pilot initiatives and projects which drive department strategy and client satisfaction as well as other responsibilities as directed.

• Work with team leadership to identify opportunities for process improvement within the tools and the processes we use including those coordinated with our internal partners.

• Assist in training documentation and other duties to sustain and improve process performance

• Support team development and effectiveness by engaging with peers and leadership in knowledge sharing training and special projects.

• Ability to mentor and train less experienced team members

• Demonstrate Cigna values including teamwork and enterprise mindset to support a high-performance culture.

• Critical thinker with project organization and proven ability to lead and manage multiple projects simultaneously

• Demonstrate ability to coordinate resources cross-functionally to resolve complex issues and deliver results on behalf of our partners and clients

• Ability to work effectively in a dynamic team-based environment learn quickly solve problems and make decisions with minimal supervision

• Willingness to work a flexible schedule during high-volume periods to accommodate business requirements

Key Qualifications

• High school diploma or GED

• 2 years of experience in Operations Benefits and/or Benefit/claims testing quality assurance or similar roles

• Knowledge and experience with Medicare Medicaid and Exchange (HIM)preferred

• Excellent verbal and written communication skills including the ability to clearly and openly communicate status issues/risks and challenges presented to a project as well as the ability to create clear and concise presentations

• Demonstrate ability to work autonomously prioritize and manage multiple assignments/projects meet project deadlines and use critical thinking in complex situations while performing effectively under pressure.

• Excellent written and verbal communication skills; ability to interact with all levels and clients

• Adapt to a dynamic work environment learn quickly solve problems and make decisions with minimal oversight

• Demonstrate initiative commitment and ability to work under pressure and meet tight deadlines

• Strong business acumen with proven ability to leverage knowledge base to quickly come up to speed in new business areas and new projects.

• Demonstrate ability to work collaboratively with other departments to resolve complex issues with strategic and innovative solutions

• Proficient in SharePoint MS Excel MS Word PowerPoint MS Outlook