Aetna HRP Testing COE - Senior Analyst

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

TCOE is seeking a Subject Matter Expert (SME) who will assist the testing team with review and interpretation of business requirements, development of test scenarios, validation of test results and trouble-shooting issues identified during test execution. The ideal candidate will provide UM Configuration expertise and guidance on development of test execution strategies and test plans to ensure test results meet expected outcomes for multiple requirements, including but not limited to, various IFP & Medicare Advantage claim policies and Utilization Management.The Subject Matter Expert will make an impact by:

• Translating intent of business requirements into test scenarios to validate UM configuration and associated claim adjudication logic.
• Trouble-shooting HRP repair edits and issues identified during test execution.
• Reviewing UM test results to validate configurations in HRP QA environments before promotion to HRP production.
• Facilitating internal meetings with colleagues and business teams to provide test status updates, obtain clarification of business intent and discuss issues or concerns.
• Advising colleagues on development of test plans and test scenarios for various business requirements.

• 3+ years of experience in development, execution and review of test plans and test results
• 3+ years of HRP experience
• Claims adjudication background
• Knowledge of MedCompass and Utilization Management Configuration.
• Knowledge of Medicare Advantage and/or IFP products, claim policies and procedures.
• Experience interpreting business requirements to identify claim adjudication impacts and test scope.

• 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.