Description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

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

At CVS Health, we are committed to building a world of health around every consumer, supported by passionate colleagues who strive to transform healthcare. As the nation's leading health solutions company, we serve millions of Americans through our local presence, digital channels, and a workforce of over 300,000 purpose-driven professionals.

We are seeking a Manager - Aetna Claim Adjudication System (ACAS) Contract Pricing SME to join our Testing Center of Excellence (TCOE). This role requires deep expertise in provider contracts and pricing logic. The SME will review test outputs, analyze pricing mismatches between previous and new contracts, validate pricing logic, interpret contract terms, and coordinate reviews with Business Implementation & Readiness (BIR) teams. The ideal candidate will possess strong analytical skills, attention to detail, and the ability to translate complex contract language into actionable testing insights.

Key Responsibilities

Pricing Validation & Analysis:

• Review test outputs and identify discrepancies in pricing between old and new contracts.
• Validate pricing logic and ensure accurate interpretation of contract terms.

Contract Expertise:

• Apply deep knowledge of provider contracts to assess compliance and accuracy.
• Interpret complex contract language and translate it into testable requirements.

Mismatch Resolution:

• Investigate root causes of pricing mismatches and recommend corrective actions.
• Collaborate with IT and business teams to resolve identified issues.

Stakeholder Coordination:

• Partner with BIR teams to ensure timely review and approval of pricing test results.
• Communicate findings and recommendations clearly to stakeholders.

Governance & Documentation:

• Maintain detailed documentation of test results, mismatches, and resolutions.
• Ensure adherence to governance standards and compliance requirements.

Continuous Improvement:

• Identify opportunities to enhance pricing validation processes and tools.
• Contribute to best practices for contract interpretation and pricing accuracy

Required Qualifications

• 3 + years in provider contract testing, pricing validation, or related functions.
• 3 + years of strong understanding of claims adjudication systems and pricing methodologies.
• 3 + years of proficiency in Excel and data analysis tools.

Preferred Qualifications

• Experience with commercial and Medicare programs and provider network pricing.
• Familiarity with automation tools and test management systems.
• Knowledge of regulatory requirements impacting pricing and contracts.
• Advanced analytical and problem-solving skills.
• Ability to interpret complex contract terms and apply them to testing scenarios.
• Excellent communication and stakeholder management abilities.

Education

Bachelor's degree required or equivalent work experience.

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.

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: 12/31/2025

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