Executive Director, Benefit and Quality Operations – Aetna

CVS Health • Wellesley, CT

4d • Hybrid

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary At Aetna, our health benefits business is committed to helping members achieve their best health in an affordable, convenient, and comprehensive manner. Combining the assets of our health insurance products and services with CVS Health’s unrivaled presence in local communities and pharmacy benefits management capabilities, we’re joining members on their path to better health and transforming the health care landscape in new and exciting ways every day. Aetna is seeking an Executive Director, Benefit and Quality Operations to lead quality assurance for claims platforms within the Business and Technology Shared Services organization. This role is responsible for ensuring the integrity of the end‑to‑end benefits payment process—from provider contracting through benefit configuration and claim adjudication. The Executive Director will define and execute the Aetna claims platform testing strategy and establish a robust QA operating model. This leader will ensure that all claims platform and benefits configuration releases are accurate, compliant, high‑quality, and financially sound. The ideal candidate brings proven experience standing up and leading a testing organization, deep technical expertise across complex claims environments (including legacy and mainframe systems), and strong executive presence to effectively influence cross‑functional partners. Success also requires familiarity with modern testing methods, including intelligent automation and emerging QA tools, applied pragmatically within a regulated industry.

Requirements

• The candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company’s business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:
• 10+ years of industry experience, preferably in healthcare.
• 5+ years of experience in design and execution of test strategy, including unit testing, UAT, end-to-end, regression testing, financial neutrality, performance testing, and related testing practices.
• Demonstrated experience leading a testing organization, including building or standing up capabilities, operating models, governance, and metrics.
• Knowledge of claims systems, including legacy and mainframe claims processing environments, with strong technical testing and quality depth.
• Executive presence with the ability to align and influence stakeholders.
• Experience influencing across matrixed organizations and senior stakeholders without direct authority.
• Adept at execution and delivery skills; adept at business intelligence; strong collaboration and teamwork.
• Mastery of problem-solving, decision-making, and growth mindset skills.
• Ability to work Hybrid Model (in office Tuesday / Wednesday / Thursday) out of the Hartford, CT, Wellesley, MA or Jacksonville, FL offices highly preferred.

Nice To Haves

• Experience modernizing QA practices in complex, regulated environments.
• Experience leveraging AI‑enabled or intelligent automation tools to improve testing effectiveness, coverage, or efficiency, applied pragmatically in regulated healthcare environments.

Responsibilities

• Establish and Lead the Claims QA Organization Build, lead, and mature the claims platform quality assurance organization, including test domains, associated applications, and functional testing support teams. Lead area processes for the organization’s quality assurance function and ensure methods align with overall business strategy. Define governance, standards, operating rhythms, and delivery expectations across testing domains to achieve best-in-class quality, cost efficiency, and timely deliverables.
• Own Enterprise Claims Test Strategy Lead test strategy development spanning unit testing, user acceptance testing (UAT), end-to-end testing, regression testing, financial neutrality testing, performance testing, and related testing disciplines across claims platforms. Develop targeted and broad test scenarios with statistically valid volume to ensure benefits and contracts perform as expected. Establish and monitor the ongoing capabilities needed for effective test environments, including environment readiness, test data needs, and repeatable execution.
• Drive Defect Excellence and Quality Outcomes Manage defect identification, triage, resolution, and mitigation across claims platform releases. Provide executive presence to influence stakeholders and ensure defect and quality risk decisions are made with appropriate transparency and rigor, including when there is pushback on defects in the platform build. Support attainment of key financial targets by reducing the impact of configuration defects that lead to operational rework expense and late claim interest penalty expense.
• Modernize Testing Practices, Standards, and Measurement Formulate organizational policies, goals, and objectives based on best practices in the field. Establish integration of standards with quality principles and methodology; embed quality practices into delivery processes. Deliver recommendations to standardize metrics and reporting and improve transparency, predictability, and outcomes. Design, develop, and re-engineer process improvements to enhance quality, efficiency, and delivery performance. Maintain awareness of the evolving Aetna testing environment, including intelligent automation and emerging tools, applying them where they strengthen outcomes in a regulated claims environment.
• Partner and Influence Across the Organization Develop relationships with technical and organizational leaders to ensure alignment and achievement of the long-term testing vision. Advise leadership on proposed process implementation and refinement issues, including quality risk tradeoffs.
• Lead People, Vendors, and Financial Performance Manage team performance through regular feedback and formal performance review processes to ensure exceptional services, engagement, motivation, and development. Oversee staffing headcount, vendor staffing or expense as applicable, and overall financial performance to budget.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Director