Facets QA Lead

Tata Consultancy Services; Kansas City (MO); On-site; USD 80,000 - 100,000; Full time

Benefits offered by this job

Discretionary Annual Incentive

Comprehensive Medical Coverage

Maternal & Parental Leaves

Insurance Options

Commuter Benefits

Vacation and Sick Leave

Legal Assistance and 401K Plan

Job summary

Tata Consultancy Services is seeking an experienced professional for a role focused on Healthcare Claims Processing. The position involves leading end-to-end testing for Claims, Enrollment, and Billing modules, and acting as a Subject Matter Expert for Claims Processing and EDI transactions.

The ideal candidate will possess strong expertise in EDI formats and Facets, ensuring compliance with HIPAA regulations for all testing activities. Excellent stakeholder communication skills are essential. A comprehensive benefits package is included.

Responsibilities

• Lead end-to-end testing for Claims, Enrollment, and Billing modules.
• Act as SME for Claims Processing and EDI transactions.
• Validate Facets Claims and Membership workflows.
• Design and execute test strategies, test plans, and test cases.
• Perform EDI validation (837, 835, 834) including mock data creation.
• Manage defect lifecycle, triage, and resolution tracking in ADO.
• Ensure HIPAA compliance in all testing activities.
• Validate ITS claims processing across SF, DF, RF flows.
• Drive quality metrics, reporting, and release sign-offs.
• Collaborate with business, development, and partner teams for E2E validation.

Skills

Healthcare Claims Processing lifecycle

EDI formats (837/P/I/D, 835, 834)

Facets (Claims + Enrollment modules)

Azure DevOps (ADO)

HIPAA compliance

Healthcare QA/Testing

Test Lead in Facets projects

Claims Adjudication & Payment workflows

Handling claims denials and adjustments

Mocking EDI files (837/835/834)

ITES claims processing

Member Enrollment workflows (Medicaid, Medicare, ACA)

Billing lifecycle for member enrollment

Data validation and reconciliation

Functional and end-to-end testing

Agile/Scrum methodologies

Stakeholder communication and coordination

Risk identification and defect triage

Education

BACHELOR OF COMPUTER SCIENCE

Tools

Azure DevOps (ADO)

Job description

Required Skills

• Strong SME knowledge in Healthcare Claims Processing lifecycle
• Expertise in EDI formats – 837 (P/I/D), 835, 834
• Hands-on experience in Facets (Claims + Enrollment modules)
• Proficiency in Azure DevOps (ADO) for QA tracking
• Knowledge of HIPAA compliance and payer systems
• 8+ years of experience in Healthcare QA/Testing
• 4+ years of experience as Test Lead in Facets projects
• Deep understanding of Claims Adjudication & Payment workflows
• Experience in handling claims denials, adjustments, and reprocessing
• Strong exposure to EDI claim and remittance transactions
• Experience in mocking and validating EDI files (837/835/834)
• Knowledge of ITS claims processing (SF, DF, RF)
• Experience in Member Enrollment workflows (Medicaid, Medicare, ACA)
• Understanding of Billing lifecycle for member enrollment
• Hands-on experience with ADO Test Plans, Test Suites, and Defect tracking
• Ability to perform data validation and reconciliation activities
• Strong experience in functional and end-to-end testing
• Familiarity with Agile/Scrum methodologies
• Excellent stakeholder communication and coordination skills
• Experience in risk identification, defect triage, and RCA

Responsibilities

• Lead end-to-end testing for Claims, Enrollment, and Billing modules
• Act as SME for Claims Processing and EDI transactions
• Validate Facets Claims and Membership workflows
• Design and execute test strategies, test plans, and test cases
• Perform EDI validation (837, 835, 834) including mock data creation
• Manage defect lifecycle, triage, and resolution tracking in ADO
• Ensure HIPAA compliance in all testing activities
• Validate ITS claims processing across SF, DF, RF flows
• Drive quality metrics, reporting, and release sign-offs
• Collaborate with business, development, and partner teams for E2E validation

Qualifications

• BACHELOR OF COMPUTER SCIENCE

Salary

$80,000- $100,000 a year

Benefits Summary

• Discretionary Annual Incentive
• Comprehensive Medical Coverage: Medical & Health, Dental & Vision, Disability Planning & Insurance, Pet Insurance Plans
• Family Support: Maternal & Parental Leaves
• Insurance Options: Auto & Home Insurance, Identity Theft Protection
• Convenience & Professional Growth: Commuter Benefits & Certification & Training Reimbursement
• Time Off: Vacation, Time Off, Sick Leave & Holidays
• Legal & Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing

Managerial Skills (Optional)

• Leading and Mentoring team members
• Strong problem-solving and critical thinking
• Ability to work with minimal supervision
• Documentation and knowledge sharing
• Excellent communication