CVS Health
Position Summary
The Testing Center of Excellence (TCOE) is seeking a Subject Matter Expert 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 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, Medicare pricing methodologies and contracts, various Medicare Advantage claim policies, ClaimsXten/Cotiviti edits, Utilization Management and Provider Demographics. Responsibilities
Translating intent of business requirements into test scenarios to validate configurations and associated claim adjudication logic.
Trouble-shooting (HealthRules Payer) HRP repair edits and issues identified during test execution.
Reviewing 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
3+ years of experience in development, execution and review of test plans and test results.
3+ years of HRP experience.
Claims adjudication background.
Preferred Qualifications
Knowledge of Medicare Advantage products, claim policies and procedures.
Experience interpreting business requirements to identify claim adjudication impacts and test scope.
Education
Bachelor’s degree is preferred; comparable work experience may be considered. Anticipated Weekly Hours
40 Time Type
Full time Pay Range
The typical pay range for this role is: $66,330.00 - $145,860.00 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. Benefits
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.
For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 09/30/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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The Testing Center of Excellence (TCOE) is seeking a Subject Matter Expert 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 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, Medicare pricing methodologies and contracts, various Medicare Advantage claim policies, ClaimsXten/Cotiviti edits, Utilization Management and Provider Demographics. Responsibilities
Translating intent of business requirements into test scenarios to validate configurations and associated claim adjudication logic.
Trouble-shooting (HealthRules Payer) HRP repair edits and issues identified during test execution.
Reviewing 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
3+ years of experience in development, execution and review of test plans and test results.
3+ years of HRP experience.
Claims adjudication background.
Preferred Qualifications
Knowledge of Medicare Advantage products, claim policies and procedures.
Experience interpreting business requirements to identify claim adjudication impacts and test scope.
Education
Bachelor’s degree is preferred; comparable work experience may be considered. Anticipated Weekly Hours
40 Time Type
Full time Pay Range
The typical pay range for this role is: $66,330.00 - $145,860.00 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. Benefits
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.
For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 09/30/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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