Quality Review and Audit Lead Analyst - Express Scripts - Hybrid

- Senior

St. Louis, MO

About the position

The Quality Review and Audit Lead Analyst 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 that focuses on collaborating and empowering each other to deliver complex implementations, benefit changes, and enterprise projects on time. The Quality Review and Audit Lead Analyst will collaborate with various business operational stakeholders with the opportunity to engage with 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 Lead Analyst will identify and have the opportunity to 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 is client-facing and supports Centene's Medicare, Medicaid, and Exchange (HIM) lines of business, with an emphasis on benefits, clinical, and network configuration.

Responsibilities

• Co-lead implementation testing of new Centene implementations, existing business changes and initiatives.
• Work directly with Account Teams, Client Service Teams, Operations, and Product partners to understand client setup/intent and testing scenarios.
• Meet client expectations, deadlines, impacts/changes, and ensure delivery of client contractual testing requirements to drive overall client satisfaction.
• Create, review, and confirm testing data for quality and accuracy.
• Ensure the execution of the business testing completion is within the expected completion date.
• Communicate status and risk to Centene Benefit Validation and Testing leadership.
• Ensure identified defects/issues are documented, tracked and escalated to appropriate teams.
• Report on business testing status.
• Attend and participate in project status, client calls, and ad hoc meetings.
• Identify and participate in developing ongoing quality controls and testing procedures.
• Support lessons learned and provide recommendations to improve processes.
• Support initiatives and projects that drive department strategy and client satisfaction.
• Work with team leadership to identify opportunities for process improvement.
• Identify and request training, documentation, and other duties to sustain and improve process performance.
• Demonstrate critical thinking with project organization skills.
• Ability to work effectively in a dynamic team-based environment.

Requirements

• High school diploma 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).
• Excellent verbal and written communication skills.
• Demonstrate ability to work autonomously and exercise judgment in evaluating strategic and tactical challenges.
• Excellent written and verbal communication skills; ability to interact with all levels and clients.
• Adapt and thrive in a dynamic work environment.
• Demonstrate initiative, commitment, and ability to work under pressure.
• Strong business acumen, with a proven ability to leverage a knowledge base to quickly become proficient in new business areas.
• Demonstrate ability to work collaboratively with other departments.
• Proficient in SharePoint, MS Excel, MS Word, PowerPoint, MS Outlook.

Benefits

• Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
• 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.
• Annual bonus plan eligibility.