Test Lead - Healthcare Payer Testing

Test Lead — Healthcare Payer Testing 

Location: Remote  

Employment Type: Full-Time

Role Overview

We are seeking a Test Lead with healthcare payer domain expertise to drive test planning and execution for payer system engagements. This role is hands-on — you own test case design, defect management, and daily execution quality while collaborating closely with the Test Manager and cross-functional delivery teams.

Key Responsibilities

Develop detailed test cases, scenarios, and scripts for claims processing, enrollment, benefits, provider data, and EDI transaction flows
Lead functional, integration, regression, and UAT cycles for assigned payer modules
Analyze requirements and business rules — identify gaps, ambiguities, and testability issues before execution begins
Own defect lifecycle management: logging, triage, root cause classification, retest, and closure tracking
Validate EDI transactions (834, 837, 835, 270/271, 820) against payer business rules and X12 standards
Support compliance and regulatory test cycles — ICD updates, CMS mandates, state-specific Medicaid rules
Coordinate with developers, BAs, and configuration teams to resolve blockers and clarify expected behavior
Produce daily/weekly execution status reports with defect metrics, coverage status, and risk flags
Manages offshore QA analysts.

Required Qualifications

• 5+ years in software QA/testing
• 2+ years in a lead or senior tester role
• Solid experience testing U.S. healthcare payer systems — claims, enrollment, benefits, or provider network
• Working knowledge of EDI X12 transactions and HIPAA compliance requirements
• Hands-on test case design experience using boundary analysis, equivalence partitioning, and negative testing techniques
• Proficiency in defect tracking and test management tools (JIRA, Zephyr, ALM, or equivalent)
• Ability to read and interpret payer business rules, EOPs, benefit plan documents, and SLAs
• Strong attention to detail — payer system defects have financial and compliance consequences

Geographic Responsibility:  Remote, US

Type of Employment: Full-time, permanent 

FLSA Classification (USA Only): Exempt 

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:  

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.  

• Work across multiple time zones in a hybrid or remote work environment. 

• Long periods of time sitting and/or standing in front of a computer using video technology. 

• May require travel dependent on company needs. 

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990.  Candidates may be required to go through a pre-employment criminal background check. 

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. 

#LI-Remote 

**The annual US base salary range for this position is $100,000 to $120,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.