Senior Test / QA Analyst
New
H
HJ StaffingHealthcare
100% Remote (US-based), Pacific Standard Time (PST)Full-TimeSenior
Salary not disclosed
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Job Details
- Experience
- 5+ years of software QA/testing experience, with at least 3 years specifically supporting health plan claims processing systems
- Required Skills
- SQLAgileJiraHIPAA
Requirements
- 5+ years of software QA/testing experience.
- 3+ years specifically supporting health plan claims processing systems.
- Strong experience with medical claims adjudication including COB, subrogation, remittance processing, and claims editing platforms.
- Hands-on experience working within health plan core administration platforms such as TriZetto FACETS, QNXT, ika, PCM, or similar systems.
- Proficiency with SQL for backend validation.
- Experience in Agile/Scrum environments utilizing Jira, Azure DevOps, Rally, or similar project management tools.
- Strong understanding of ICD-10, CPT/HCPCS coding structures, modifier logic, and revenue codes.
- Excellent analytical, troubleshooting, documentation, and communication skills.
Responsibilities
- Design and execute comprehensive test plans, test cases, and test scripts for health plan claims processing systems.
- Validate end-to-end claims adjudication workflows including intake, pricing, benefit application, coordination of benefits (COB), payment processing, and EOB generation.
- Perform robust testing and validation of HIPAA-compliant EDI transaction sets including 837P/837I, 835, 270/271, 276/277, and 834 transactions.
- Verify claims payment accuracy against fee schedules, contracted provider rates, DRG/APR-DRG methodologies, per diem structures, and MAC pricing logic.
- Lead defect triage, root cause analysis, regression testing, and release validation.
- Utilize SQL for deep-dive test data validation and backend verification activities.
- Ensure strict compliance with ACA, CMS, NCQA, HIPAA, state DOI mandates, and validate code set updates.
- Partner with business analysts, claims operations, developers, and external trading partners to translate requirements into testable scenarios.
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