Manager - ACAS Contract Pricing Test SME, CVS Health

CVS Health

Location:
United States, Work at Home

Category:
IT - Administration

Contract Type:
Employment contract

Salary:

66330.00 - 145860.00 USD / Year

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Job Description:

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.

Job Responsibility:

Review test outputs and identify discrepancies in pricing between old and new contracts
Validate pricing logic and ensure accurate interpretation of contract terms
Apply deep knowledge of provider contracts to assess compliance and accuracy
Interpret complex contract language and translate it into testable requirements
Investigate root causes of pricing mismatches and recommend corrective actions
Collaborate with IT and business teams to resolve identified issues
Partner with BIR teams to ensure timely review and approval of pricing test results
Communicate findings and recommendations clearly to stakeholders
Maintain detailed documentation of test results, mismatches, and resolutions
Ensure adherence to governance standards and compliance requirements
Identify opportunities to enhance pricing validation processes and tools
Contribute to best practices for contract interpretation and pricing accuracy

Requirements:

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
Bachelor's degree required or equivalent work experience
Deep expertise in provider contracts and pricing logic
Strong analytical skills and attention to detail
Ability to translate complex contract language into actionable testing insights

Nice to have:

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

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access
Bonus, commission or short-term incentive program eligibility

Additional Information:

Job Posted:
November 23, 2025

Expiration:
December 31, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Manager - ACAS Contract Pricing Test SME