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Position Summary

As a Benefit Testing Manager, you will be part of Client Benefit Services QA team that is engaged across multiple functions including Clinical and Benefit Organization, with particular emphasis on solving problems, process improvement and increase automation opportunity within testing team. You will have the opportunity to utilize your PBM technical skills and logical skills to analyze the business process, insert technology to solve problems and improve efficiency of Benefit testing operation. You will be responsible for performing analytical skill to review different Medicaid state compliance Benefit programs and translate those into business rule and define test strategy and scripts to validate the same.

You will independently work on leading day to day activities of key Benefit testing initiatives and provide business rules for Automation tools. You will also play a vital role in finding opportunities for improvements and problem-solving issues encountered by the team. This team works closely with internal and external partners to deliver key strategic projects, manage applications, and improve Client Services processes. You will actively participate on client calls. You will define Benefit test requirements, create test plans, and execute test scenarios, capture test results, present test results to all stakeholders and seek approval.

To be successful you will bring your developed skills as an innovative, analytical, energetic, problem solver. If this describes you, then become part of our “go-to team”. You will define Benefit Test Strategy, Train testing resources, Define and Drive Enterprise level Test Initiative to ensure Benefit accuracy, Provide Subject Matter Expertise to enhance Benefit Quality and Client Satisfaction, and act as a single point of contact to reduce PGs on Quality within Medicare, Medicaid, Commercial and Exchange line of business.
 

As a Benefit Testing Manager/ Subject Matter Expert (SME), you will own following responsibilities:

Take full ownership and serve as subject matter expert for testing all client’s benefit plan designs in the Benefit space of Utilization Management and Formulary, and present Test Results to Internal Benefits team and External Clients.Understanding client needs and Benefit requirements, translate into Test Scenarios to validate Benefit Configuration and Benefits Coding.Expertise on EZTEST (claim processing tool), Sales force, EZQYERY, EXCEL Macro, Formulary management system and Benefit Serve/Benefit builder.Translate CMS and state mandate Benefit program/rule and define business rule and validate before code promotion to production.Facilitating internal and external meetings and presentations to provide status updates and ensure Benefit configuration accuracy for Client’s requirement.Building relationships with key client partners through a consultative approach to fully understand Benefit components of client benefit plan design needs.Define Benefit test requirements, create test plans, and execute test scenarios, capture test results, present test results to all stakeholders.Assess project risks and provide risk mitigation plans, weekly statuses with leadership and other stakeholders.Develop process improvement initiatives in support of department efficiency. Pinpoint areas of opportunity and training needs.Advise colleagues in performing set ups and testing for various benefit plan designs in Benefit space of client requirements.Work through the various phases of the project until all issues have been resolved, cleanup complete and all reportable items are closed to the satisfaction.Identify Benefit testing gap for Commercial, Medicaid, Medicare, and Exchange Line of BusinessCreate Benefit Test Strategy for identified Benefit testing gap areas.Propose/develop testing automation tools to enhance testing accuracy and rapid turnaround.

Your success will be driven by exceeding client satisfaction score targets as well as driving Production defect leakage for clients. Your healthcare industry knowledge in the areas of Formulary Management, Drug Utilization Management, and Claims Adjudication will also contribute to your success. You will operate in a dynamic environment with tight deadlines so ability to operate. The contributions you will make as a Test SME will position CVS Health as a leader in client satisfaction and service in the PBM marketplace.

Required Qualifications
Required Qualifications:  5+ years of Healthcare/PBM experience

Preferred Qualifications

Excellent communication (Verbal and Written) and collaboration skills.Demonstrated ability to manage and organize projects from start to completion.Computer proficiency in MS Office applications (Microsoft Word; Microsoft Excel, Microsoft PowerPoint, and Microsoft Outlook).Claim Adjudication knowledge.PBM and Healthcare knowledge.Formulary and Utilization Management knowledge is mandatory.EZQUERY/Sequel hands-on.Expertise in defining Benefit test conditions.Ability to coach, train, and mentor resources with Benefit testing process.Claim processing tool (EZTEST), Sales force.Medicaid state specific Benefit program knowledge.

Education

Bachelor’s degree: Equivalent experience can also be considered

Pay Range

The typical pay range for this role is:

$60,300.00 - $132,600.00

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 11/29/2024

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