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Sr Manager HRP Claims Testing

Sr Manager HRP Claims Testing

CVS HealthWorcester, MA, US
1 day ago
Job type
  • Full-time
Job description

Senior Manager - HRP Testing Subject Matter Expert (SME)

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 :

  • Serving 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.
  • Translating intent and benefit requirements into test scenarios to validate benefit configuration and benefits coding.
  • Possessing expertise in the HRP platform.
  • Translating CMS and state mandate benefit programs / rules to validate configurations before promotion to production.
  • Facilitating internal and external meetings and presentations to provide status updates and ensure benefit configuration accuracy.
  • Defining benefit test requirements, creating test plans, reviewing test results, and presenting them to stakeholders.
  • Assessing risks, providing risk mitigation plans, and delivering weekly status updates to leadership and other stakeholders.
  • Developing process improvement initiatives to enhance department efficiency, identify areas of opportunity, and address training needs.
  • Advising colleagues on setting up and testing various benefit plan designs based on client requirements.

Required Qualifications :

  • 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 : $82,940.00 - $182,549.00

    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.

    • Application window for this opening will close on : 10 / 31 / 2025

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

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    Claim Manager • Worcester, MA, US