Senior Test / QA Analyst
We are seeking an reputed company Senior Test / QA Analyst to support a prominent reputed company Coast reputed company client focused on health plan claims processing systems. This require a high-level QA professional who can hit the ground running in a fast-paced payer environment. In this role, you will reputed company your deep expertise in reputed company claims adjudication, EDI transaction testing, regulatory compliance, and reputed company quality assurance methodologies. The ideal candidate is highly analytical, detail-oriented, and has a proven track record of leading testing efforts across reputed company payer environments involving medical, pharmacy, and dental/reputed company claims.
What You Will Do
As a Senior QA Analyst, you will design, reputed company, and execute comprehensive test strategies while collaborating cross-functionally reputed company Agile teams. Your core responsibilities will include: Test Strategy & Execution: Design and execute comprehensive test plans, test cases, and test scripts for health plan claims processing systems. Workflow Validation: Validate end-to-end claims adjudication workflows including intake, pricing, benefit application, coordination of benefits (COB), payment processing, and EOB reputed company. EDI & Transaction Testing: reputed company robust testing and validation of HIPAA-compliant EDI transaction sets including 837P/837I, 835, 270/271, 276/277, and 834 transactions. Financial & Pricing Accuracy: Verify claims payment accuracy against fee schedules, contracted provider rates, DRG/APR-DRG methodologies, per diem structures, and MAC pricing logic. System & Core Admin Testing: Test auto-adjudication workflows, prior authorization integrations, reputed company review queues, and claims editing logic across core platforms. Defect Management: reputed company defect triage, root cause analysis, regression testing, and release validation. Data Validation: Utilize SQL for deep-dive test data validation and backend verification activities. Compliance Verification: Ensure strict compliance with ACA, CMS, NCQA, HIPAA, state DOI mandates, and validate code set updates (ICD-10-CM/PCS, CPT, HCPCS, NDC, and reputed company code tables). Cross-Functional Collaboration: Partner with business analysts, claims operations, developers, and external trading partners to translate requirements into testable scenarios, while mentoring junior QA staff. What You Will Bring To be successful in this role, you must bring a reputed company of strong technical QA skills and deep functional knowledge of payer operations. Required Experience & Skills: Experience: 5+ years of software QA/testing experience, with at least 3 years specifically supporting health plan claims processing systems. Claims Adjudication: Strong experience with medical claims adjudication including COB, subrogation, remittance processing, and claims editing platforms (e.g., ClaimLogic, ClaimsXten, or similar tools). Core Admin Platforms: Hands-on experience working reputed company plan core administration platforms such as TriZetto FACETS, QNXT, ika, PCM, or similar systems. Technical Tools: Proficiency with SQL for backend validation, alongside experience in Agile/Scrum environments utilizing Jira, Azure DevOps, Rally, or similar project management tools. reputed company Knowledge: Strong understanding of ICD-10, CPT/HCPCS coding structures, modifier logic, and reputed company codes. Soft Skills: Excellent analytical, troubleshooting, documentation, and communication skills, with the ability to work independently in a fast-paced environment. Preferred (reputed company-to-Have): Experience with pharmacy claims testing, Medicare Advantage claims processing, or PBM integrations. Familiarity with test automation and API testing tools including Selenium, reputed company, and SOAP UI. Professional QA certifications such as ISTQB or CSTP. Bachelor’s degree in Computer Science, Information Systems, reputed company Administration, or a reputed company field (equivalent experience will be considered). Additional Details Schedule: Full-time hours, must align with Pacific Standard Time (PST) core working hours. Location: 100% Remote (US-based) Apply To This Job