QA Test Engineer - AI-Driven Claims Validation

TechDigital Group; New York (NY); On-site; USD 95,000 - 125,000; Full time

Job summary

TechDigital Group is seeking a QA/Testing professional with expertise in Pharmacy Claims and PBM testing. You will validate NCPDP D.0/F6 migrations, perform end-to-end validation, and drive test planning, scripts, and traceability across SDLC, Agile, and cross-functional teams.

Responsibilities include SQL data validation, defect management, and release readiness, with a focus on accuracy in claims adjudication, pricing, eligibility, COB, and messaging. AI tooling experience is a plus.

Qualifications

• Experience testing Pharmacy Claims and PBM domains.
• Familiar with NCPDP D.0/F6 standards and migrations.
• Proficient in test planning, case/scripts, and traceability.
• Strong SQL and backend data validation skills.
• Knowledge of QA reporting, defect management, and release readiness.
• Able to work in SDLC with Agile/Scrum/Waterfall approaches.
• Experience with AI tools for test automation is a plus.
• Ability to perform end-to-end, integration, SIT/UAT, and production validation.

Responsibilities

• Plan and design test strategies for Pharmacy Claims & PBM domains.
• Create test cases, scripts, and traceability matrices.
• Validate adujustments in claims, pricing, eligibility and COB data.
• Perform backend data checks using SQL and data reconciliation.
• Manage defects, retesting, and QA reporting for releases.
• Collaborate across teams in SDLC and cross-functional settings.
• Implement or leverage AI tools to enhance test automation.
• Coordinate E2E, SIT, UAT, and production validation activities.

Skills

Pharmacy Claims Testing

NCPDP D.0/F6 Standards

Test Planning & Scripts

SQL & Data Validation

QA & Defect Management

Agile/Scrum/SDLC

AI Test Automation

End-to-End Validation

Job description

Job Details:
• Pharmacy Claims & PBM Domain Testing
• NCPDP D.0 / F6 Standards & Migration Validation
• Claim Adjudication, Eligibility, COB, Pricing & Reject Messaging
• Test Planning, Test Cases, Test Scripts, Traceability & Test Data
• Functional, SIT, UAT, Regression, Integration, E2E, Parallel, Release & Production Validation
• SQL, Backend Data Validation, Reconciliation & Claims Data Analysis
• Payer Sheet, Field Mapping, Business Rules & Transaction Specification Analysis
• Defect Management, Retesting, QA Reporting & Release Readiness
• SDLC, Agile/Scrum/Waterfall & Cross-functional Collaboration
• AI Tools for Test Automation