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Position Summary
CVS Health is seeking a strategic and transformational Lead Director, Commercial Plan and Benefit Quality Assurance to lead quality and testing strategy for Aetna's Commercial line of business with a primary focus on the ACAS claims platform. This role will serve as a key leader within the Testing Center of Excellence (Testing COE), responsible for advancing quality outcomes across claims processing, provider contracts, benefit configuration, pricing, and Open Enrollment readiness.
The Lead Director will drive the transformation of testing from a traditional defect-detection model into a proactive quality engineering and quality control capability focused on reducing claims rework, improving payment accuracy, enhancing provider and member experience, and mitigating operational risk.
This leader will partner closely with Business, Operations, Product, Technology, and vendor organizations to establish quality as a strategic business enabler. Additionally, the role will be responsible for modernizing testing capabilities through AI, automation, advanced analytics, and quality engineering practices to improve testing effectiveness, optimize delivery costs, and accelerate business value realization.
- Develop and execute the quality strategy for the Commercial business and ACAS claims platform, aligning quality initiatives with organizational goals and business outcomes.
- Drive Aetna wide quality transformation focused on reducing claims rework, improving first-pass accuracy, and strengthening operational excellence.
- Establish quality governance frameworks that proactively identify and mitigate risks before they impact members, providers, or business operations.
- Serve as a trusted advisor to senior leadership on quality, operational readiness, risk management, and continuous improvement opportunities.
- Lead initiatives that improve member and provider experiences through enhanced quality controls, defect prevention, and improved production stability.
- Partner with Operations and Business leaders to identify root causes of claims rework and implement sustainable quality improvements.
- Drive improvements in payment accuracy, claims processing quality, and release readiness across Commercial products and services.
- Establish measurable quality outcomes that demonstrate value through reduced rework, increased efficiency, and improved customer satisfaction.
- Oversee end-to-end testing strategy and delivery across provider contracts, claims processing, benefit configuration, pricing validation, implementations, and Open Enrollment readiness.
- Ensure comprehensive testing coverage through risk-based approaches across functional, integration, end-to-end, regression, financial neutrality, performance, and user acceptance testing.
- Lead defect management processes, root cause analysis, and continuous improvement initiatives to reduce production defects and operational disruptions.
- Build scalable testing capabilities, standards, methodologies, and governance processes that support growth and quality objectives.
- Define and execute a strategic roadmap for testing modernization through AI, automation, and quality engineering practices.
- Drive adoption of intelligent automation solutions to improve testing efficiency, expand coverage, accelerate execution, and reduce manual effort.
- Leverage AI-enabled capabilities for test design, test data generation, defect prediction, root cause analysis, production monitoring, and quality insights.
- Continuously optimize testing processes, operating models, and resource utilization to improve effectiveness and reduce delivery costs.
- Establish metrics and dashboards that measure automation value, testing effectiveness, productivity improvements, and business impact.
- Lead, develop, and mentor a high-performing organization of quality professionals.
- Foster a culture of accountability, innovation, continuous improvement, and customer-centric thinking.
- Build strong partnerships across Business, Operations, Technology, and external partners to achieve long-term quality objectives.
- Drive organizational change and champion modern quality engineering practices across the enterprise.
Required Qualifications
- 10+ years of experience in Quality Assurance, Quality Engineering, Testing, or related disciplines.
- 7+ years of experience designing and executing enterprise-wide testing and quality strategies within complex healthcare environments.
- 5+ years of leadership experience driving strategic initiatives and organizational transformation with measurable business outcomes.
- 5 + years of experience leading large-scale testing programs including integration, end-to-end, regression, financial neutrality, performance, and user acceptance testing.
- Proven ability to influence senior leadership and drive cross-functional alignment across business and technology organizations.
- Strong analytical, strategic thinking, communication, and stakeholder management skills.
- Experience leading teams in a dynamic and highly matrixed environment.
- Ability to work in a hybrid work environment.
Preferred Qualifications
- Deep functional and technical knowledge of the ACAS claims platform, including claims adjudication, benefit configuration, pricing, provider contract implementation, and Commercial business operations.
- Hands-on experience with ACAS, PERS, and APC applications, with a strong understanding of how these platforms support Commercial plan configuration, enrollment, claims processing, and operational workflows.
- Strong understanding of the end-to-end case installation and plan installation lifecycle, including requirements interpretation, configuration validation, implementation, testing, and production readiness activities.
- Demonstrated experience leading testing and quality initiatives supporting plan builds, renewals, benefit changes, provider contract implementations, and Open Enrollment readiness.
- Ability to assess business and operational impacts of configuration changes across ACAS, PERS, APC, and downstream claims processing systems.
- Experience developing test strategies and quality controls that ensure accurate implementation of plans, benefits, contracts, and claims processing rules while minimizing production defects and claims rework.
- Demonstrated success reducing operational defects, claims rework, and production issues through effective quality management practices
Education
- Bachelor's Degree required, or equivalent combination of education and relevant experience.
- Master’s degree in business administration, Information Technology, Healthcare Administration, Engineering, or a related field preferred.
Pay Range
The typical pay range for this role is:
$100,000.00 - $231,540.00
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. This position also includes an award target in the company’s equity award program.
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 10+ years of experience in Quality Assurance, Quality Engineering, Testing, or related disciplines.
- 7+ years of experience designing and executing enterprise-wide testing and quality strategies within complex healthcare environments.
- 5+ years of leadership experience driving strategic initiatives and organizational transformation with measurable business outcomes.
- 5+ years of experience leading large-scale testing programs including integration, end-to-end, regression, financial neutrality, performance, and user acceptance testing.
- Proven ability to influence senior leadership and drive cross-functional alignment across business and technology organizations.
- Strong analytical, strategic thinking, communication, and stakeholder management skills.
- Experience leading teams in a dynamic and highly matrixed environment.
- Ability to work in a hybrid work environment.
- Bachelor's Degree required, or equivalent combination of education and relevant experience.
- Deep functional and technical knowledge of the ACAS claims platform, including claims adjudication, benefit configuration, pricing, provider contract implementation, and Commercial business operations.
- Hands-on experience with ACAS, PERS, and APC applications.
- Strong understanding of the end-to-end case installation and plan installation lifecycle, including requirements interpretation, configuration validation, implementation, testing, and production readiness activities.
- Experience leading testing and quality initiatives supporting plan builds, renewals, benefit changes, provider contract implementations, and Open Enrollment readiness.
- Ability to assess business and operational impacts of configuration changes across ACAS, PERS, APC, and downstream claims processing systems.
- Experience developing test strategies and quality controls that ensure accurate implementation of plans, benefits, contracts, and claims processing rules while minimizing production defects and claims rework.
- Demonstrated success reducing operational defects, claims rework, and production issues through effective quality management practices.
- Master's degree in business administration, Information Technology, Healthcare Administration, Engineering, or a related field preferred.
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
