Aetna HRP Testing COE - Senior Analyst - Remote Eligible

Subject Matter Expert (SME) - Remote

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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.

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.

Key attributes:

• 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.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $112,200.00

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.

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.

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