Sr Manager HRP Claims Testing

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

At Aetna, our health benefits business, we are committed to helping our members achieve their best health in an affordable, convenient, and comprehensive manner. Combining the assets of our health insurance products and services with CVS Health's unrivaled presence in local communities and their pharmacy benefits management capabilities, we're joining members on their path to better health and transforming the health care landscape in new and exciting ways every day.

Aetna is seeking a Senior Manager - HRP Testing Subject Matter Expert (SME) who will bring in-depth subject matter knowledge to support the testing team. This individual will play a crucial role in providing expertise and guidance in testing methodologies, tools, and best practices. They will collaborate with the team to develop and implement effective testing strategies, ensuring high-quality deliverables. The Senior Manager - Testing SME will also contribute to the continuous improvement of testing processes and drive innovation within the organization

You'll make an impact by:

• Serve as a subject matter expert for testing Medicare benefit plan designs on the Health Rules Payer platform and present test results to the Internal Benefits team.
• Translate intent and benefit requirements into test scenarios to validate benefit configuration and benefits coding.
• Possess expertise in the HRP platform.
• Translate CMS and state mandate benefit programs/rules to validate configurations before promotion to production.
• Facilitate internal and external meetings and presentations to provide status updates and ensure benefit configuration accuracy.
• Define benefit test requirements, create test plans, review test results, and present them to stakeholders.
• Assess risks, provide risk mitigation plans, and deliver weekly status updates to leadership and other stakeholders.
• Develop process improvement initiatives to enhance department efficiency, identify areas of opportunity, and address training needs.
• Advise colleagues on setting up and testing various benefit plan designs based on client requirements.

Required Qualifications

The candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company's business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:

• 5+ years of experience in design and execution of test strategy, which includes components such as unit testing, user acceptance testing, end to end, regression testing, financial neutrality, performance testing, etc.  
• Adept at execution and delivery (planning, delivering, and supporting) skills 
• Prior experience working with HRP
• Knowledge of Claims adjudication and Medicare lines of business

Preferred Qualifications

• Mastery of problem solving and decision-making skills
• Mastery of growth mindset (agility and developing yourself and others) skills 

Education Requirements

• Bachelor's degree required or equivalent experience

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.  This position also includes an award target in the company's equity award program. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.