PBM Tester (NCPDP D.0 to F6 implementation) :: Remote

TestingXperts; Washington (District of Columbia); On-site; USD 100,000 - 140,000; Full time

Job summary

TestingXperts is seeking a Test Engineer with strong pharmacy claims and PBM testing experience to support an NCPDP D.0 to F6 implementation in Washington, DC. You will validate transaction changes, eligibility and COB scenarios, and coordinate with PBM SMEs, BA, development, and business teams.

Key responsibilities include creating test plans and data, validating submit/reject flows, and performing regression and production validation.

Qualifications

• Experience with NCPDP D.0 and F6 in PBM/pharmacy testing.
• Strong SQL and data validation skills for test data review.
• Experience in SIT, UAT, regression, and production validation.
• Ability to collaborate with PBM SMEs, BA, development and business teams.

Responsibilities

• Analyse D.0 and F6 requirements, payer sheets, field mapping and specs to identify test scenarios.
• Create and maintain test plans, scenarios, cases, scripts, data, and traceability.
• Validate pharmacy claim transactions including eligibility, COB, rejects, pricing and messaging.
• Perform functional, regression, integration, end-to-end, batch, API/interface and production validation.
• Develop and execute SQL queries to validate claims data and downstream impacts.
• Coordinate testing dependencies with PBM teams and stakeholders and manage defects.

Skills

NCPDP D.0

NCPDP F6

PBM Claims

SQL

SIT/UAT

Regression

Data Validation

Tools

JIRA

Job description

We're looking for a Test Engineer with strong pharmacy claims and PBM testing experience to support an NCPDP D.0 to F6 implementation.

This role is responsible for validating transaction changes, claim adjudication outcomes, eligibility and coordination of benefits scenarios, reject messaging, payer sheet impacts, data mapping, regression coverage, and production readiness. The ideal candidate has strong pharmacy claims testing experience, working knowledge of NCPDP D.0, the ability to learn and validate F6 changes, strong SQL and data validation skills, and experience collaborating with PBM SME's, BA, development, and business teams.

Key experience: NCPDP D.0, NCPDP F6, PBM/pharmacy claims, SQL, SIT, UAT, Parallel, regression testing, trading partner testing, release testing, production validation, and post-implementation defect triage.

Key Responsibilities

• Analyse NCPDP D.0 and F6 implementation requirements, payer sheets, field mapping documents, business rules, and transaction specifications to identify test scenarios and validation needs.
• Create and maintain test plans, test scenarios, test cases, test scripts, test data, and traceability for pharmacy claim transaction testing.
• Analyses requirements, coordinate with BA's / Subject Matter Experts.
• Validate NCPDP pharmacy claim request and response transactions, including claim submission, reversal, eligibility, coordination of benefits, reject codes, messaging, pricing, accumulators, and coverage determination scenarios.
• Perform functional, regression, integration, end-to-end, batch, database, API/interface, UAT support, Parallel and production validation testing for D.0 to F6 changes.
• Develop and execute SQL queries to validate claims data, member eligibility, benefit setup, pricing, accumulators, drug data, payer configuration, and downstream reporting impacts.
• Compare D.0 and F6 transaction behaviour to confirm that new, modified, and retired fields are processed correctly across impacted systems.
• Identify, document, track, retest, and close defects using approved defect management processes and tools.
• Support test data creation for positive, negative scenarios.
• Coordinate testing dependencies with PBM SME's, business users, developers, PBM teams, and downstream application teams.
• Coordinates Onshore / Offshore as needed.
• Working knowledge on AI tools for automation.
• Prepare daily or weekly status updates, defect reports, test execution metrics, test coverage summaries, and implementation risk updates.
• Participate in requirement reviews, design walkthroughs, payer sheet reviews, field mapping reviews, release readiness meetings, and implementation checkpoints.