Job Description
Job Description
- Develops and executes comprehensive testing processes for system enhancements and new products and processes encompassing all aspects of customer service including claims, enrollment, provider contracts, and benefits administration.
- Responsible for creating and executing defined unit testing processes to provide quality audits for vendor contracts prior to implementation.
- Assists with testing simple system enhancements.
- Prepares and executes a comprehensive test plan and test scripts to provide quality audits for vendor contracts to ensure quality and accuracy is maintained.
-Verifies that system functions according to user requirements and conforms to established guidelines.
- Follows standardized best practices for documenting and executing simple to moderately complex test
plans.
- Validates test results, documents discrepancies, and follows through with resolutions to ensure all issues are resolved.
- Reports progress of problem resolution to management.
- Communicates test outcomes to end users for sign-off on the results.
- Serves as liaison between the system end users and the IT team.
- Performs other duties as required.
Required Qualifications
- Broad knowledge of medical terminology, claims, customary and reasonable cost containment, coordination of benefits, diagnosis coding, and general customer services sources.
- 5+ years related experience in a service center claims processing or managed care operational role.
- Minimum of one year recent and related system processing, payment, and benefits experience, preferably IDX managed care.
- Excellent verbal and written communication skills.
Preferred Qualifications
Please see required qualifications
Education
High School Diploma or equivalent.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
- Develops and executes comprehensive testing processes for system enhancements and new products and processes encompassing all aspects of customer service including claims, enrollment, provider contracts, and benefits administration.
- Responsible for creating and executing defined unit testing processes to provide quality audits for vendor contracts prior to implementation.
- Assists with testing simple system enhancements.
- Prepares and executes a comprehensive test plan and test scripts to provide quality audits for vendor contracts to ensure quality and accuracy is maintained.
-Verifies that system functions according to user requirements and conforms to established guidelines.
- Follows standardized best practices for documenting and executing simple to moderately complex test
plans.
- Validates test results, documents discrepancies, and follows through with resolutions to ensure all issues are resolved.
- Reports progress of problem resolution to management.
- Communicates test outcomes to end users for sign-off on the results.
- Serves as liaison between the system end users and the IT team.
- Performs other duties as required.
Required Qualifications
- Broad knowledge of medical terminology, claims, customary and reasonable cost containment, coordination of benefits, diagnosis coding, and general customer services sources.
- 5+ years related experience in a service center claims processing or managed care operational role.
- Minimum of one year recent and related system processing, payment, and benefits experience, preferably IDX managed care.
- Excellent verbal and written communication skills.
Preferred Qualifications
Please see required qualifications
Education
High School Diploma or equivalent.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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