[Remote] Sr Manager HRP Claims Testing at CVS Health

Connecticut, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

5+ years of experience in design and execution of test strategy, which includes 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
Bachelor's degree required or equivalent experience
Preferred: Mastery of problem solving and decision-making skills
Preferred: Mastery of growth mindset (agility and developing yourself and others) skills

Responsibilities

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

Skills

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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