Medicaid Claims QA Analyst(Healthcare)

Infinite Computer Solutions; Washington (District of Columbia); À distance; USD 80 000 - 120 000; Plein temps

Résumé du poste

Infinite Computer Solutions is seeking a Senior QA Tester for remote work focusing on MMIS health care projects. You will lead testing across the claims lifecycle, from intake to payment, ensuring quality and compliance.

You will collaborate with clients and development teams, design test plans, execute tests, and report results. Strong healthcare domain knowledge and excellent communication are essential.

Qualifications

• Strong healthcare domain experience with Medicaid/Medicare knowledge.
• Hands-on experience in claims processing and adjudication processes.
• Ability to run queries and perform basic system analysis and RCA.
• Experience configuring benefits across sub-systems in claims systems.
• Excellent written and spoken communication; multitasking across teams and clients.

Responsabilités

• Validate the entire flow from claim intake to payment and reporting.
• Interface testing between systems and data flows.
• Design test cases based on business rules and system configurations.
• Use test mgmt tools like ADO and JIRA; use Postman for API testing.

Connaissances

Healthcare domain

Claims testing

Communication skills

multitask

Outils

Postman

JIRA

ADO

Description du poste

Job Title: Senior QA Tester

Location: Remote

Type: Full Time/W2 with Infinite Computer Solutions

Job Description

Role summary

Responsible for claims testing for MMIS health care projects. Drive the test strategy and process, domain knowledge, perform analysis of business requirements, designs and develops test plans, ensures quality process, coordinates with customers on delivery and deployments. Works in team environment and provides testing guidance throughout the entire life cycle. Responsible to meet customer expectations, troubleshoot problems in the application and assisting customers in implementation decisions.

Roles And Responsibility

• Candidate should have strong health care domain experience and should have good knowledge of Medicaid and Medicare.
• Candidate should have hands-on experience on claims processing and Adjudication processes.
• Must have good experience in Reference code/data sets required in Claims adjudication.
• Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
• Should be able to run queries and perform basic system analysis, RCA etc.,
• Should work closely with the client and development team during the stages of development, and conduct demos at completion of milestone, track and close feedback from such demos
• Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
• Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.
• In depth understanding of Claims and Claims lifecycle:
• Member
• Provider
• Claim submission Paper and EDI X12
• Adjudication
• Payment Cycle (Finance)
• Reporting
• Claim Types:
• Professional
• Dental
• Institutional
• Pharmacy
• Encounters and Capitation
• Claim Formats:
• EDI X12 formats like 837P/I/D
• X12 formats 835, 834, 270/271, 276/277
• Claim System:
• Familiarity with systems like CMdS, GHS, Facets and etc

Testing Knowledge And E2E Testing

• Validate the entire flow from claim intake to payment and reporting.
• Interface testing - Test integration points between systems
• Design test case based on business rules, coverage policies, and system configurations.
• Familiarity with test management tools like ADO, JIRA,
• Interface/API testing tools like Postman

Technical Skills

• SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).
• EDI Tools: Validating X12 files.
• Interface Testing: Understanding how data flows between systems and formats and use tools like postman