Quality Review and Audit Advisor - Express Scripts - Remote

Express Scripts Pharmacy Benefit Services; Missouri; On-site; USD 79,000 - 131,000; Full time

Benefits offered by this job

Health plans

401(k)

Life insurance

Tuition reimbursement

Paid time off

Job summary

Express Scripts Pharmacy Benefit Services is seeking a Quality Review and Audit Advisor to lead pharma audit and PWP data initiatives. You will coordinate with internal teams, troubleshoot issues, track deliverables and ensure contract terms are followed.

This role requires advanced Excel, strong data analysis, and the ability to manage multiple deadlines. You will gather and validate large datasets, build data analytics, and provide ongoing support to Pharma Audit and PWP teams.

Qualifications

• Bachelor’s degree or equivalent in a related field.
• Experience supporting pharma manufacturer audits or client audits.
• Strong data analysis with validation of large datasets.
• Advanced Excel skills and healthcare/pharma industry knowledge.

Responsibilities

• Lead pharma audit and PWP issues resolution and meet deadlines.
• Troubleshoot questions from audits and discuss with pharma/auditors.
• Track data deliverables and monitor contractual data requests.
• Perform systems analysis and SQL/Macro work to streamline processes.
• Provide ongoing data support to Pharma Audit and PWP teams.

Skills

Audit support experience

Data analysis

Contract interpretation

Cross-functional collaboration

Advanced Excel

SQL

Attention to detail

Communication/presentation

Education

Bachelor's degree in Finance, Business, Accounting, Economics, or related field

Tools

SQL

Macros

Job description

Position Summary

The Quality Review and Audit Advisor works with our pharmaceutical manufacturers (and/or their auditors) and management as well as other Express Scripts (ES) subject matter experts as a lead to resolve issues noted during the Pharma Audit process or during Pharma Web Portal (PWP) review. This Advisor level Analyst will serve as a project lead and tracks status on data deliverables, monitors contract terms to ensure pharma is requesting appropriate data, and assists with troubleshooting issues and questions arising from pharma audits and/or the PWP. As a Quality Review and Audit Advisor, you will work cross functionally with other ES subject matter experts to build out data analytics, obtain applicable electronic files/data when necessary, ensuring all information is included and readable. Assist other members of the team with performing their job duties as needed. Provides data and ongoing support to both Pharma Audit and PWP subject matter experts as needed.

The Quality Review and Audit Advisor works with our pharmaceutical manufacturers (and/or their auditors) and management as well as other Express Scripts (ES) subject matter experts as a lead to resolve issues noted during the Pharma Audit process or during Pharma Web Portal (PWP) review. This Advisor level Analyst will serve as a project lead and tracks status on data deliverables, monitors contract terms to ensure pharma is requesting appropriate data, and assists with troubleshooting issues and questions arising from pharma audits and/or the PWP. As a Quality Review and Audit Advisor, you will work cross functionally with other ES subject matter experts to build out data analytics, obtain applicable electronic files/data when necessary, ensuring all information is included and readable. Assist other members of the team with performing their job duties as needed. Provides data and ongoing support to both Pharma Audit and PWP subject matter experts as needed.

Essential Functions

• Works with Pharma Audit and PWP as lead to ensure issues are resolved and deadlines are met by working independently as well as cross functionally with internal departments.
• Assists with troubleshooting issues and questions arising from audits.
• Discusses any pertinent issues with Pharma (and/or their auditor), understanding and managing their expectations and working through any limitations that may be experienced due to confidentiality of information, etc.
• This position requires the analyst to be able to anticipate pharma’s needs as it relates to audit or the PWP.
• It also requires the ability to deal with sensitive situations.
• Tracks status and serves as technical lead for PWP, and acts as lead for pharma audit during routine audits and monitors contracts to ensure clients are requesting appropriate data.
• Fields various requests for information and provides ongoing support for Client Audit as well as other subject matter experts as needed.
• Steps in when necessary to assist with department workload needs.
• Look for opportunities to initiate process improvement and perform all necessary systems analysis and SQL, Macro functions to ensure that the department is moving towards more efficient processes.
• Special projects as assigned.

Qualifications

• 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 along with presentation skills.

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 78,800 - 131,300 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.

At The Cigna Group, 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), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

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 need a reasonable accommodation to complete the online application process, please email [e-mail] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.