Cigna

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

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 77,000 - 128,400 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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.