Quality Review and Audit Advisor

🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $78.8k - $131.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Work with pharmaceutical manufacturers and/or their auditors, management, and Express Scripts subject matter experts as a lead to resolve issues identified during the Pharma Audit process or Pharma Web Portal review • Serve as project lead and track status on data deliverables • Monitor contract terms to ensure pharmaceutical manufacturers request appropriate data • Assist with troubleshooting issues and questions arising from pharmaceutical audits and/or the Pharma Web Portal • Work cross-functionally with Express Scripts subject matter experts to build data analytics • Obtain applicable electronic files and data when necessary, ensuring all information is included and readable • Provide data and ongoing support to Pharma Audit and Pharma Web Portal subject matter experts • Ensure audit and portal issues are resolved and deadlines are met • Discuss pertinent issues with pharmaceutical manufacturers and/or their auditors, manage expectations, and work through confidentiality limitations • Anticipate pharmaceutical manufacturers' needs related to audits or the Pharma Web Portal • Track status and serve as technical lead for the Pharma Web Portal • Act as lead for pharmaceutical audits during routine audits • Field requests for information and provide ongoing support for Client Audit and other subject matter experts • Assist with department workload needs • Initiate process improvements and perform systems analysis, SQL, and Macro functions to improve efficiency • Complete special projects as assigned

🎯 Requirements

• Bachelor's degree in Finance, Business, Accounting, Economics, or related field • Experience supporting pharmaceutical manufacturer audits, compliance reviews, or client audit activities • Experience reviewing and interpreting contract language and validating data requests against contractual requirements • Strong data analysis experience, including gathering, validating, and reconciling large datasets • Advanced Microsoft Excel skills • Healthcare, PBM, pharmaceutical manufacturer, pharmacy, or managed care industry experience • Knowledge of Express Scripts systems and operations preferred • Previous experience working with cross functional departments to research and resolve issues using innovative solutions • Demonstrated ability to meet multiple deadlines and manage a dynamic workload • Well organized • Demonstrated analytical and problem solving skills • Detail oriented • Excellent verbal and written communication skills • Presentation skills • If working at home, internet connection through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload

🏖️ Benefits

• Annual bonus plan eligibility • Medical insurance • Vision insurance • Dental insurance • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload for home working