Job Details

Quality Review & Audit Lead Analyst

Express Scripts is currently seeking a Quality Review & Audit Lead Analyst. The Quality Review & Audit Lead Analyst is a key contributor to the Pharmacy Benefit Services (PBS) Operations Audit Team, responsible for leading audit and quality assurance initiatives across the PBS Operations team. This role ensures compliance with regulatory and contractual requirements, supports all types of PBS Ops audit activities, and drives continuous improvement through data analysis and process optimization.

Responsibilities:

• Lead and manage multiple audit projects, including client-initiated and government audits (e.g., State Readiness, Market Conduct, Pre-delegation).
• Perform quality reviews of signature control items to validate and ensure alignment with audit requirements.
• Analyze large datasets using Excel to identify discrepancies and ensure data integrity.
• Develop and maintain standard operating procedures (SOPs) for audit and quality review processes.
• Collaborate with cross-functional teams (e.g., Internal Audit, Regulated Markets, Client Audit, Sales & Account Management, IT) to resolve issues and implement improvements.
• Prepare formal written responses to audit findings and ensure timely and accurate documentation.
• Monitor AuditBoard and other systems to ensure compliance in audit deliverables.
• Identify and implement process improvements to enhance audit efficiency and effectiveness.

Qualifications:

• High School Diploma or GED required. Bachelor's degree in Business, Finance, Healthcare Administration, or related field preferred.
• 2+ years of experience in auditing, quality assurance, or pharmacy benefit management (PBM).
• Advanced proficiency in Microsoft Excel (pivot tables, VLOOKUP, formulas), Word, PowerPoint, and Smartsheet.
• Strong analytical, problem-solving, and organizational skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities and meet tight deadlines.
• Experience working independently and collaboratively in dynamic environments.
• Knowledge of CMS regulations and PBM operations preferred.

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 69,600 - 116,000 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.