MMIS Claims Testing Lead (Remote)

Groupe Kardol; Malvern (Chester County); On-site; USD 85,000 - 105,000; Full time

Job summary

The CarmansG team is seeking a Claims Tester to lead testing for MMIS health care projects. This role requires hands-on experience with Medicaid/Medicare, claims processing, and adjudication, and involves designing test plans and coordinating with clients on delivery.

You will validate end-to-end claim flows, interface tests, and data integrity using SQL, EDI X12, and API tools like Postman, while guiding the QA team through milestones and demos.

Qualifications

• Strong healthcare domain experience, with Medicaid/Medicare knowledge.
• Hands-on experience in claims processing and adjudication processes.
• Experience with reference data sets for claims adjudication.
• Experience configuring benefits or programs in claims systems across subsystems.
• Ability to run queries and perform basic system analyses (RCA).
• Capable of demos with client and development teams at milestones, tracking feedback.

Responsibilities

• Validate end-to-end claim flow from intake to payment and reporting.
• Perform interface testing between systems and test data flows.
• Design test cases based on business rules and configurations.
• Utilize test management tools (ADO, JIRA) and API testing (Postman).
• Collaborate with client, QA, and development teams throughout the life cycle.

Skills

Healthcare domain

Medicaid/Medicare

Claims processing

Adjudication

Reference data sets

Benefits configuration

SQL queries

Test planning

Rationale/RTM

Communication

Tools

ADO

JIRA

Postman

SQL

Job description

The CarmansG team is seeking a Claims Tester to lead testing for MMIS health care projects. This role requires hands-on experience with Medicaid/Medicare, claims processing, and adjudication, and involves designing test plans and coordinating with clients on delivery.

You will validate end-to-end claim flows, interface tests, and data integrity using SQL, EDI X12, and API tools like Postman, while guiding the QA team through milestones and demos.