Healthcare Claims QA Engineer (HRP, EDI 837)

Luxoft; Mexico; On-site; PHP 5,016,000 - 7,524,000; Full time

Job summary

Luxoft is seeking a QA tester to join a healthcare claims testing project for a US non-profit. The role focuses on validating HealthRules Payer (HRP) workflows, EDI 837, Blue Card, and HRP-to-TPA integrations, ensuring accurate claims processing and pricing.

You will collaborate with Product Owners, BA, developers, and QA members across the US, India, and Mexico to develop test scenarios, execute cases, document defects, and support production issue investigations.

Qualifications

• 4+ years of experience in healthcare claims processing or testing.
• Strong hands-on knowledge of HealthRules Payer (HRP) and EDI 837.
• Experience with Blue Card, HRP-to-TPA workflows, and claims adjudication.
• SQL knowledge for data validation and claims analysis.

Responsibilities

• Perform functional and end-to-end testing of healthcare claims within HealthRules Payer (HRP).
• Validate local claims processing workflows, benefits, pricing, and adjudication.
• Test EDI 837 files and HRP-to-TPA workflows.
• Perform testing for Blue Card claims and related business scenarios.
• Validate HRP-to-TPA workflows, including upstream and downstream claims transactions.
• Create and execute test cases and test scenarios based on business and functional requirements.
• Analyze claims-processing results and identify inaccuracies or inconsistencies in business rules, configurations, pricing, and claim payments.
• Document, track, retest, and support resolution of defects identified during testing.
• Support investigation and resolution of production issues related to claims, benefits, and pricing configurations.
• Participate in business requirements and solution-review sessions to identify testing requirements and potential gaps.
• Collaborate with business and IT teams to validate system changes, enhancements, and configuration updates before production deployment.
• Provide subject-matter expertise regarding healthcare claims processing and HRP workflows.
• Maintain appropriate testing and system documentation.

Skills

EDI 837

Blue Card

Claims Testing

SQL

Azure DevOps

Education

Bachelor's degree in Business Administration, MIS, CS, or related field

Tools

HealthRules Payer (HRP)

Job description

Luxoft is seeking a QA tester to join a healthcare claims testing project for a US non-profit. The role focuses on validating HealthRules Payer (HRP) workflows, EDI 837, Blue Card, and HRP-to-TPA integrations, ensuring accurate claims processing and pricing.

You will collaborate with Product Owners, BA, developers, and QA members across the US, India, and Mexico to develop test scenarios, execute cases, document defects, and support production issue investigations.