Full-Time
Lead Director
Multiple Teams
CVS Health
10,001+ employees
Healthcare, insurance, PBM, and retail pharmacy
Compensation Overview
$100k - $231.5k/yr
Company Historically Provides H1B Sponsorship
Hartford, CT, USA
Hybrid
Hybrid work environment required.
Bachelor's, Master's
 Engineering Management (1) |
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- 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.
- A Bachelor's Degree is required, or an equivalent combination of education and relevant experience.
- 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.
- 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.
- A Master’s degree in business administration, Information Technology, Healthcare Administration, Engineering, or a related field.
CVS Health operates as a diversified health services company in the United States, organized into Health Care Benefits, Pharmacy & Consumer Wellness, and Health Services. Its offerings include medical insurance products, retail and mail-order prescription drugs, and pharmacy benefit management (PBM) services, all connected through its integrated platform. By combining insurance, retail pharmacy, PBM, and health solutions, CVS Health coordinates care and controls costs across touchpoints for individuals, employers, and government programs. The company aims to lower health care costs while improving access and health outcomes for customers.
Company Size
10,001+
Company Stage
IPO
Headquarters
Woonsocket, Rhode Island
Founded
1963
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Simplify's Take
What believers are saying
- CVS raised 2026 adjusted EPS guidance to $7.90-$8.10 on August 5, 2026.
- CVS Caremark settled FTC probes July 14, 2026, reducing legal overhang.
- CVS expanded Eli Lilly weight-loss access in early fourth quarter 2026.
What critics are saying
- Louisiana's February 2026 $45 million settlement keeps PBM reform pressure on Caremark margins.
- Aetna paid $117.7 million on March 11, 2026 for Medicare coding fraud allegations.
- Federal and state antitrust actions threaten a Caremark-Aetna breakup by 2027.
What makes CVS Health unique
- CVS integrates Aetna, Caremark, and 9,000 pharmacies across 87 million PBM members.
- CVS combines retail, insurance, and PBM data under one operating system.
- CVS launched Google Cloud partnerships and AI tools across claims, service, and engagement.
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Benefits
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Disability Insurance
401(k) Retirement Plan
Company Equity
Wellness Program
Professional Development Budget
Paid Vacation
Paid Holidays
Company News
CVS Health stock has declined 12.3% over the past month, sitting about 15% below its 52-week high, though it remains up 34% over the trailing twelve months. The company's revenue reached approximately $415 billion, up 7.4% year-over-year. Management raised its full-year 2026 adjusted earnings per share guidance by $0.60 to a range of $7.90 to $8.10. For 2027, the company anticipates membership declines at Caremark and continued 340B programme pressure, offset by Aetna's recovery, which added over $2 billion in adjusted operating income in the first half of 2026. Management considers a 2027 adjusted EPS outlook of at least $8.44 reasonable. Historically, CVS has experienced varied recovery periods following market downturns, with some rebounds taking years rather than months.
CVS Health and Roche could benefit from the growing GLP-1 drug market, alongside current leaders Eli Lilly and Novo Nordisk. CVS Health has improved its financial performance, with second-quarter revenue rising 7.3% year-over-year to $106.1 billion and adjusted earnings per share increasing 42.5% to $2.58. The pharmacy chain offers all approved GLP-1 medicines in the US, including Eli Lilly's Zepbound and Foundayo, plus Novo Nordisk's Wegovy. CVS also provides low-cost online consultations at $29 to assess patient eligibility for GLP-1 drugs. Beyond GLP-1 initiatives, CVS is addressing previous business challenges and is positioned to capitalise on rising healthcare spending in the US over the next decade.
CVS Health has appointed Teresa Heitsenrether, a senior executive from JPMorgan Chase with extensive data and analytics experience, to its board of directors. The move follows the resignation of board member Larry M. Robbins. The appointment signals CVS Health's focus on technology and data-driven healthcare at the governance level. The company, valued at approximately $120bn, operates an integrated healthcare model spanning insurance, pharmacy benefits, and retail services. Heitsenrether's data expertise aligns with CVS Health's strategy to leverage digital capabilities and operational efficiency across its businesses, including Aetna and Caremark. The company faces challenges including high debt levels and reimbursement pressures in a competitive market alongside UnitedHealth Group and Cigna.
CVS Health reported second quarter revenue of $106.1 billion, beating analyst estimates of $99.41 billion by 6.7%. Adjusted earnings per share came in at $2.58, surpassing expectations of $1.85 by 39.4%. Management attributed strong performance to specialty pharmacy and Medicare Advantage, with CEO David Joyner noting improvements from actions taken in Aetna and Caremark. The company raised its full-year adjusted EPS guidance to $8 at the midpoint. However, analysts raised concerns about sustainability. Management acknowledged ongoing challenges in the 340B program and normalisation of script share gains from Rite Aid. To offset these headwinds, executives pointed to biosimilars and investments in service technology. The company has committed $20 billion over a decade to AI and technology investments, with operational savings already being realised.
Nine pharmacy benefit managers will integrate TrumpRx prescription drug pricing into their benefit tools, effective 1 January 2027. The Pharmaceutical Care Management Association and participating PBMs—including CVS Health, Express Scripts, Humana, and OptumRx—will display cash prices from TrumpRx alongside plan coverage costs. The agreement covers commercial, Medicare, and Medicaid plans. Patients will see TrumpRx prices for all listed drugs, whether through presidential deals or standard pricing. CMS Administrator Dr Mehmet Oz said the commitment will help patients compare prices and find better deals. PCMA CEO David Marin stated the transparency will allow consumers to make better-informed choices about prescription drug costs. Some PBMs will use Real Time Benefit Tools to display pricing comparisons, whilst others may employ different methods.