QA Specialist- REMOTE

Job Summary 

We are seeking a QA Analyst to support testing efforts related to claims configuration, benefit setup, pricing, and adjudication within a healthcare payer environment. This individual will be responsible for executing test plans, validating configuration changes, documenting defects, and ensuring system functionality meets business requirements.

The ideal candidate will have healthcare payer experience and possess a strong understanding of claims processing. Candidates who can distinguish between configuration issues, claims adjudication issues, and other system-related defects during testing will be highly valued.

   
Primary Responsibilities 

• Execute functional, integration, regression, and user acceptance testing activities.
• Validate configuration changes and enhancements within the claims administration platform.
• Develop and execute test cases, test scenarios, and test scripts.
• Analyze test results and document defects clearly and accurately.
• Validate claims adjudication outcomes against expected business rules.
• Work closely with configuration specialists, business analysts, developers, and business stakeholders to resolve issues.
• Participate in requirement reviews and provide feedback regarding testability and potential risks.
• Support release testing and production validation activities.
• Maintain testing documentation and testing metrics.

• 3+ years of QA or software testing experience in a healthcare payer environment.
• Experience testing claims processing systems.
• Strong understanding of healthcare claims adjudication and payer operations.
• Experience creating and executing test cases and documenting defects.
• Ability to analyze test results and identify root causes of issues.
• Strong communication and documentation skills.
• Experience testing HealthRules Payer (HRP) implementations or enhancements.
• Experience validating claims, benefits, provider, and reimbursement configurations.
• Familiarity with healthcare claim pricing and payment methodologies.
• Exposure to Medicare, Medicaid, Commercial, or Managed Care products.
• Experience with defect tracking and test management tools.