EDI QA Analyst

Opteamix LLC; Bengaluru; On-site; INR 700,000 - 1,000,000; Full time

Job summary

Darwinbox Digital Solutions Pvt. Ltd. is seeking an EDI QA Analyst (Carrier Operations) to validate outbound carrier/vendor files and ensure they meet business and carrier requirements.

You will work with external vendors and internal teams, develop test plans, and drive data integrity across the file delivery lifecycle. You will design test scenarios for eligibility, enrollment, and life events, perform data validation using SQL, and monitor post-production carrier error reports to drive

Qualifications

• Bachelor’s degree in Computer Science or related field or equivalent experience.
• 2+ years of experience in health insurance or Health & Welfare (H&W) benefits administration.
• Experience working with carrier files, EDI transactions, or HIPAA 834 files in production/operational environments.
• Strong understanding of eligibility and enrollment processes, including effective date logic and life events.
• Hands-on experience with SQL for data validation, reconciliation, and defect analysis.
• Strong analytical skills with high attention to detail in regulated environments.

Responsibilities

• Validate outbound carrier/vendor files (ANSI/HIPAA 834) for structure, format, eligibility, and carrier requirements before transmission.
• Collaborate with external carriers/vendors and internal teams to validate file behavior and resolve discrepancies.
• Develop and execute structured test scenarios covering eligibility rules, enrollment transactions, life events, and carrier-specific behaviors across testing phases.
• Trace and reconcile data from upstream systems through platform outputs to final vendor files using SQL, reports, and control totals to ensure data integrity.

Skills

Health insurance

Carrier files & EDI

Eligibility & enrollment

SQL data validation

QA best practices

Defect identification

Analytical skills

Quality Management Systems (QMS)

EDI testing

COBRA processes

Test automation

AI-assisted testing

Test data preparation

Data modelling concepts

JIRA

Education

Bachelor’s degree in Computer Science or related field

Tools

JIRA

Job description

The VendorQuality Assurance Analyst (EDI QA Analyst – Carrier Operations) is responsiblefor vali dating vendor file outputs to ensure they meet defined business andcarrier requirements. This role supports Health & Welfare (H&W)benefits administration by performing comprehensive testing and validation ofoutbound carrier files and associated data workflows prior to transmission toexternal vendors.

The EDI QAAnalyst works closely with external vendors during implementations tocommunicate testing expectations, coordinate validation activities, and addressvendor feedback. Operating in a production-adjacent environment, the roleensures data accuracy, file integrity, and carrier readiness through structuredtest planning, test data preparation, scenario validation, defectidentification and classification, and thorough documentation within thecarrier file/EDI delivery lifecycle.

In addition,the analyst collaborates cross-functionally with requirements, development, andimplementation teams to develop comprehensive test plans, manage testingactivities, and work through ticketing queues to ensure timely and high-qualityfile delivery.

Post-production,the EDI QA Analyst is responsible for ongoing monitoring, review, andresolution of carrier error reports, while identifying trends and opportunitiesfor continuous process improvement.

Key Responsibilities and Duties

• Validate outbound carrier/vendor files(ANSI/HIPAA 834 and related formats) for structural integrity, formatcompliance, eligibility accuracy, and carrier-specific requirements beforetransmission.
• Collaborate with external carriers/vendors andinternal teams, including development and operations, to validate file behaviorand resolve discrepancies.
• Develop and execute structured test scenarioscovering eligibility rules, enrollment transactions, life events, andcarrier-specific behaviors across internal and external testing phases.
• Trace and reconcile data from upstream systemsthrough platform outputs to final vendor files using SQL, reports, and controltotals to ensure data integrity.

Test Planning& Requirements Traceability

• Translate carrier/vendor and businessrequirements into structured test plans, reusable test cases, and traceablevalidation scenarios aligned to standardized templates.

Test DataPreparation

• Identify, prepare, and manage representativetest populations across systems and reporting environments to supportvalidation cycles.

DefectIdentification & Routing

• Analyze validation results, classify defects(requirements, configuration, data, system issues), and manage QA ticketsthrough defined workflows, ensuring proper routing, status tracking, ownership,and timely closure.
• Provide regular status updates on QA progress,risks, and dependencies aligned to timelines and release schedules.
• Maintain QA documentation (test plans,validation evidence, file layouts, queries, defect patterns) while buildingreusable test assets, vendor test plan libraries, and supporting futureautomation initiatives.
• Help establish and maintain a vendor test planlibrary in support of all vendor relationships.
• Drive automation and validation improvements.
• Review carrier acknowledgement and error reports(e.g., 999, rejection reports).
• Investigate and resolve rejected records.
• Coordinate corrections and reprocessing.
• Ensure timely resolution within SLA.
• Analyze recurring carrier errors and identifypatterns.
• Provide insights into upstream data orconfiguration issues.
• Recommend improvements to reduce rework andincrease first-pass success.

Mandatory skills

Project Mandatory Skills

Project Desired Skills

• Health insurance or Health & Welfare (H&W) benefitsadministration
• Carrier files, EDI transactions, or HIPAA 834 files
• Eligibility and enrollment processes, including effective date logic and lifeevent transactions
• SQL for data validation, reconciliation, and defect analysis
• QA best practices and structured test planning
• Defect identification, classification, and ticket management
• Strong analytical skills and attention to detail

• Familiarity with Quality Management Systems (QMS)
• Experience with EDI testing and carrier integration environments
• Exposure to COBRA processes within benefits administration
• Experience with test automation and test case management tools
• Familiarity with AI-assisted testing or quality engineering practices
• Experience preparing, validating, and analyzing test data across multiplesystems
• Understanding of data models and relational database concepts
• Experience with JIRA or similar defect tracking/ticketing systems

Qualifications

Required Qualifications

• Bachelor’s degree in Computer Science or arelated technical field (or equivalent experience).
• Minimum of 2 years of experience in healthinsurance or Health & Welfare (H&W) benefits administration.
• Experience working with carrier files, EDItransactions, or HIPAA 834 files in a production or operational environment.
• Strong understanding of eligibility andenrollment processes, including effective date logic and life eventtransactions.
• Hands-on experience with SQL for datavalidation, reconciliation, and defect analysis.
• Strong analytical skills with a high level ofattention to detail, especially in regulated environments with low tolerancefor error.

Preferred Qualifications

• Familiarity with QA best practices and QualityManagement Systems (QMS), including frameworks that ensure consistentcompliance with customer and regulatory requirements while driving continuousimprovement and efficiency.
• Experience with EDI testing and carrierintegration environments.
• Exposure to COBRA processes within benefitsadministration.
• Experience with test automation and test casemanagement tools.
• Familiarity with AI-assisted testing or qualityengineering practices.
• Experience in preparing, validating, andanalyzing test data across multiple systems.
• Solid understanding of data models andrelational database concepts.
• Experience using defect tracking and ticketingsystems such as JIRA (or similar tools).