Lead Quality Assurance Engineer

Covetus; United States; On-site; USD 110,000 - 150,000; Full time

Job summary

Covetus is seeking a Lead QA Engineer with deep experience in the Healthcare Payer domain. The role focuses on testing Claims or Encounters, validating EDI transactions, and ensuring data integrity across payer platforms and APIs.

The ideal candidate will read EDI loops, work with Facets modules, and leverage tools like Postman, RestAssured, or SoapUI to drive robust test automation and defect triage in an Agile setting. Knowledge of Medicaid is highly valued.

Qualifications

• Experience in healthcare payer QA testing, including Medicaid/Medicare.
• Hands-on testing of Claims or Encounters (837 transactions) and downstream payer workflows.
• Strong understanding of X12 EDI transactions (834, 837P/I/D, 277CA, 999/TA1, 835, 278, 270/271, 820).
• Proficiency with Facets modules such as Claims, Membership/Enrollment, or Provider/Network configuration.
• Experience reading EDI loops and companion guides; Edifecs or similar tools a plus.
• APIs testing and data validation experience; SQL for cross-system validation.

Responsibilities

• Lead sprint-level QA activities in Agile environments including UAT and go-live.
• Collaborate with business stakeholders, developers, product owners, and client teams.
• Own defect management, root-cause analysis, and regression testing.
• Coordinate test planning, data validation, and traceability across payer workflows.

Skills

Test design

SQL

API testing

Python/Java

Azure DevOps

qTest

AI-assisted testing

Tools

Facets

Edifecs

Postman

RestAssured

SoapUI

Job description

We are looking for a Lead QA Engineer with strong Healthcare Payer domain and quality engineering experience. The ideal candidate will have hands‑on experience testing Claims or Encounters, payer platforms, X12 EDI transactions, APIs, databases, and enterprise applications.

Key Requirements:

• Strong experience with healthcare payer processes and Lines of Business such as Medicaid, Medicare Advantage, Duals/MMP, TRICARE, or Marketplace.
• Medicaid experience is highly preferred.
• Claims or Encounter: Strong hands‑on experience testing Healthcare Claims or Encounters, including 837 transactions, adjudication/validation, reconciliation, and downstream payer workflows. Medicaid experience is highly preferred.
• Experience with Facets modules such as Claims, Membership/Enrollment, or Provider/Network configuration is highly desirable.
• Strong understanding of X12 EDI transactions, including 834, 837P/I/D, 277CA, 999/TA1, 835, 278, 270/271, and 820.
• Ability to independently read and understand EDI loops, segments, and companion guides. Edifecs or similar EDI validation tools are a plus.
• Knowledge of CMS/state Medicaid encounter submissions, HIPAA, FHIR R4/HL7, interoperability, provider directories, and audit traceability.
• Understanding of payer operations including provider data, enrollment reconciliation, prior authorization, premium billing, capitation, claims‑to‑GL reconciliation, and MLR reporting.

Quality Engineering & Technical Skills:

• Strong test design skills with the ability to derive test scenarios from business rules, requirements, and EDI companion guides.
• Experience designing source‑to‑system‑to‑downstream data reconciliation and performing root‑cause analysis and defect triage.
• Strong hands‑on SQL skills, including complex multi‑table queries for cross‑system data validation.
• Experience with API and integration testing using REST/SOAP and tools such as Postman, RestAssured, or SoapUI.
• Hands‑on experience with TOSCA and/or Robot Framework. Distributed execution experience with TOSCA is a plus.
• Experience with Azure DevOps for test management, defect tracking, and CI/CD. qTest experience is a plus.
• Strong Python or Java skills for test automation, utilities, data validation, and parsing.
• Experience with AI‑assisted testing, including LLM‑based test generation, synthetic test data, and defect analysis using tools such as Copilot, Azure OpenAI, or Claude.

Leadership & Delivery:

• Experience working in Agile/Scrum environments with ownership of sprint‑level QA activities.
• Strong defect management, root‑cause analysis, regression, SIT, UAT, and go‑live experience.
• Ability to collaborate directly with business stakeholders, developers, product owners, and client teams.
• Strong communication skills and the ability to independently lead QA discussions during UAT and business reviews.
• Offshore candidates should be comfortable maintaining approximately 4 hours of daily overlap with US Eastern Time.

Preferred Profile:

Candidates with strong Healthcare Payer QA experience and deep expertise in either Claims or Encounter testing are encouraged to apply. Experience with Medicaid, Facets, X12 EDI, SQL, API testing, and enterprise test automation will be highly valued.