Executive Director, Benefit and Quality Operations – Aetna

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.

Major 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