Healthcare Claims QA & Operations Specialist (Hybrid)

Blue Shield of CA; Rancho Cordova (CA); Hybrid; USD 85,000 - 110,000; Full time

Job summary

Blue Shield of CA is seeking an Operations Specialist to support claims teams through end-to-end testing of code changes and test-case development. You will work both independently and with teams to prevent defects and ensure compliant processing.

Responsibilities include collaborating across departments, applying Agile practices, and reporting findings to optimize efficiency while adhering to health policies and local regulations.

Qualifications

• Bachelor's degree or equivalent experience in lieu of a degree.
• Understanding of healthcare claims processing is required.
• Experience with user acceptance testing is preferred.
• Knowledge of Agile methodologies and Jira is a plus.
• Ability to work independently and show problem-solving skills.
• Strong prioritization and critical thinking abilities.

Responsibilities

• Perform end-to-end testing of new code for production readiness.
• Create test cases to identify defects and ensure correct logic.
• Collaborate with claims teams and other groups to improve processes.
• Document results and report issues to managers as needed.

Skills

Healthcare claims processing

End-to-end testing

Test case creation

Independent work

Critical thinking

Prioritization

UAT testing experience

Agile methodologies

Education

Bachelor's degree

GED/High School Diploma with 4 years related experience

Tools

Jira

Job description

Blue Shield of CA is seeking an Operations Specialist to support claims teams through end-to-end testing of code changes and test-case development. You will work both independently and with teams to prevent defects and ensure compliant processing.

Responsibilities include collaborating across departments, applying Agile practices, and reporting findings to optimize efficiency while adhering to health policies and local regulations.