Plan Testing Analyst: ACAS & Claims Validation

CVS Health

West Virginia

Hybrid

USD 60,460,000 - 140,634,000

Full time

12 days ago

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Job summary

CVS Health in the United States is seeking an Analyst, Plan Testing to support Commercial plan testing by interpreting client intent behind medical benefit designs and validating that intent through claims-based testing in ACAS. This role requires collaboration and expertise in ACAS and related platforms such as PERS/CCI to ensure plans are tested accurately before claim release.

You will review benefit intent, design test strategies and scenarios, guide testers, log defects, and continuously

Qualifications

3+ years of ACAS experience with medical plans
Experience with claims adjudication
Ability to manage multiple tasks and meet timelines

Responsibilities

Review benefit intent and translate into testing guidance for plan testers.
Design test strategies, test plans, and test scenarios that validate intended plan behavior.
Provide instructions to testers on how to execute plan testing and confirm expected claims outcomes.
Research testing issues when results do not align with expected outcomes and determine next steps.
Log confirmed defects with the appropriate contacts and support resolution through follow-up and clarification.
Resolve questions and concerns raised by plan testers throughout the testing process.
Continuously review automation opportunities and recommend improvements to strengthen testing efficiency and coverage.
Analyze defect trends and adjust test strategies, scenarios, or claims selections as needed.