QA -Facets & Medicaid Regulatory

KTek Resourcing LLC; Texas; Remote; USD 120,000 - 150,000; Full time

Job summary

KTek Resourcing LLC is seeking a Senior QA Engineer to independently validate Medicaid regulatory implementations across Facets, Mainframe, Java, DataStage, and ETL components. You will analyze state-specific regulatory requirements, design comprehensive test scenarios, and conduct end-to-end testing to ensure accuracy and compliance.

The role requires strong healthcare payer QA/testing experience, familiarity with TriZetto Facets, and the ability to validate complex data flows and interfaces

Qualifications

• Experience testing Medicaid payer solutions across Facets, Mainframe, Java, and ETL components.
• Strong knowledge of state-specific Medicaid requirements and enrollment/eligibility rules.
• Experience with data validation, SQL, and end-to-end testing across systems.
• Ability to perform functional, integration, regression, and boundary testing.

Responsibilities

• Analyze Medicaid regulatory requirements and create state-specific test scenarios.
• Validate end-to-end changes across Mainframe, Java, DataStage, and ETL processes.
• Perform SQL data validation and reconciliation.
• Conduct defect analysis and support root-cause investigations.
• Provide independent quality assessments of regulatory solutions.
• Coordinate testing across upstream/downstream applications.

Skills

Facets

Medicaid

End-to-end testing

Mainframe

Java

ETL

DataStage

Talend

APIs

SQL

Healthcare QA

Tools

TriZetto Facets

Mainframe

DataStage

Talend/TalendWorks

Job description

Mandatory-Domain expectations across all roles

osition: Senior QA Engineer – Facets & Medicaid Regulatory Solutions

Location: Remote

Medicaid Regulatory & Payer Domain & Technology Expertise:

Candidates should have strong knowledge of Medicaid managed-care operations and experience working with state-specific Medicaid requirements. They should understand how regulatory changes affect member enrollment/eligibility, coverage, claim processing, authorization, pricing/payment, data and downstream health-plan operations. They should also possess a good working understanding of Medicare and Medicare-Medicaid processes.

Candidates must have experience delivering healthcare payer solutions across a combination of TriZetto Facets, Mainframe, Java/J2EE, IBM DataStage, Talend/TalendWorks, databases, batch processing, APIs and system integrations. Candidates should have strong knowledge of Medicaid managed-care processes and state-specific regulatory requirements, together with a good understanding of Medicare and Medicaid health-plan operations, particularly member enrollment, eligibility, benefits, claims adjudication, pricing and payment.

Primary Skills

Strong Facets + Medicaid + end-to-end cross-platform testing, with ability to validate Mainframe/Java/ETL processing.

Role Summary

Seeking a Senior QA Engineer with strong Medicaid payer and Facets expertise to independently validate state-specific regulatory implementations across Facets, Mainframe, Java, DataStage, Talend/TalendWorks, and associated applications.

Key Responsibilities

• Analyze Medicaid regulatory requirements and develop comprehensive test scenarios for individual states.
• Validate end-to-end changes across:
• 2. Mainframe
• 3. Java applications
• 4. DataStage
• 5. Talend/TalendWorks
• 6. APIs/interfaces
• 8. Upstream/downstream applications
• Test regulatory changes involving member enrollment, eligibility, benefits, claims adjudication, pricing, edits, and payments.
• Validate Mainframe and Java batch/interface processing.
• Perform ETL and source-to-target data validation.
• Conduct functional, integration, end-to-end, regression, negative, and boundary testing.
• Perform independent quality assessments of regulatory solutions.
• Identify gaps between regulatory requirements, requirements documentation, technical implementation, and actual system behavior.
• Perform SQL-based data validation and reconciliation.
• Conduct defect analysis and support root-cause investigation.
• Strong healthcare payer QA/testing experience.
• Strong testing knowledge of TriZetto Facets.
• Testing experience across Mainframe and Java-based applications.
• Experience validating DataStage and Talend/TalendWorks processes.
• SQL and database testing skills.
• Strong Medicaid managed-care knowledge.
• Experience with state-specific Medicaid requirements.
• Good Medicare and Medicaid health-plan knowledge.
• Strong understanding of:
• 4. Claims
• 5. Claims adjudication
• 7. Payment
• Experience performing quality assessments for complex regulatory implementations.