Pharmacy Claims QA Lead: NCPDP D.0/F6 Expert

Infinite Computer Solutions; New Jersey; On-site; USD 90,000 - 130,000; Full time

Job summary

Infinite Computer Solutions is seeking a Test Engineer for QA in healthcare claims, focusing on NCPDP D.0 to F6 migrations. You will validate claim submissions, eligibility, COB scenarios, and ensure production readiness across systems.

The role requires strong SQL, data validation, and PBM/pharmacy testing experience, plus collaboration with PBM SMEs, BA, development, and business teams. Onshore/offshore coordination is expected.

Qualifications

• 7+ years of QA or software testing in healthcare/PBM/pharmacy claims.
• Hands-on testing of pharmacy claims, adjudication, eligibility and benefits.
• Knowledge of NCPDP Telecommunication Standard D.0; exposure to F6 preferred.
• Experience creating test plans, test cases, test scripts, test data, and traceability matrices.
• Strong SDLC knowledge with Agile, Scrum, Waterfall, Iterative or hybrid delivery.
• Solid SQL for backend validation, data reconciliation and claims data analysis.
• Ability to interpret transaction layouts, payer sheets, field requirements and mappings.
• Excellent written and verbal communication for technical/business audiences.
• Bachelor's degree preferred; equivalent industry experience considered.

Responsibilities

• Analyze NCPDP D.0 and F6 requirements, payer sheets, field mappings, and rules to identify test scenarios.
• Create and maintain test plans, scenarios, cases, scripts, data, and traceability.
• Coordinate with BAs/Subject Matter Experts.
• Validate pharmacy claim requests and responses including eligibility, COB, pricing, and rejection messaging.
• Perform functional, regression, integration, end-to-end, batch, database, API/interface, UAT support, and production validation testing.
• Develop and execute SQL queries to validate claims data and downstream reporting impacts.
• Compare D.0 and F6 behavior across systems; document updates to fields and processing.
• Identify, track, retest and close defects using approved defect processes.
• Support test data creation for positive/negative scenarios.
• Coordinate testing with PBM SMEs, business users, developers, PBM teams, and downstream apps.
• Coordinate Onshore / Offshore as needed; discuss automation opportunities.

Skills

NCPDP D.0

NCPDP F6

PBM/pharmacy claims

SQL

SIT

UAT

Regression testing

Trading partner testing

Release testing

Production validation

Post-implementation defect triage

Education

Bachelor's degree

Job description

Infinite Computer Solutions is seeking a Test Engineer for QA in healthcare claims, focusing on NCPDP D.0 to F6 migrations. You will validate claim submissions, eligibility, COB scenarios, and ensure production readiness across systems.

The role requires strong SQL, data validation, and PBM/pharmacy testing experience, plus collaboration with PBM SMEs, BA, development, and business teams. Onshore/offshore coordination is expected.