Quality Assurance Analyst

MetroPlusHealth; New York (NY); On-site; USD 70,000 - 95,000; Full time

Job summary

MetroPlus Health Plan seeks a Quality Assurance Analyst to review Claims Processing Systems for configured benefits and reimbursement methodologies. The role requires experience with claims processing systems and health care industry knowledge.

You will design test scenarios, configure QA changes, and create test claims to validate requirements. Responsibilities include meeting with business and core configuration teams, maintaining QA documentation, and driving QA process improvements while

Qualifications

• Bachelor’s degree from an accredited college or university.
• Three years of progressive QA experience including test scenario and test case creation.
• Working knowledge of UB04 and CMS 1500 claims.
• Familiarity with IT applications and systems analysis methodologies.
• Experience with Managed Health Care MIS systems and QA automation tools.

Responsibilities

• Create Test Scenarios and Test Cases based on requirements.
• QA Benefit and Provider Contract Configuration changes in claim systems to meet requirements and business needs.
• Create UB04 and CMS 1500 test claims aligning to requirements.
• Meet with business areas to gather business rules and requirements.
• Meet with Core configuration team to resolve defects.
• Create and maintain documents related to QA.
• Analyze QA processes and recommend improvements.
• Run QA Automation processes.
• Perform other QA tasks as needed

Skills

Test scenario creation

Test case creation

QA automation tools

Claims processing knowledge

IT systems analysis

Education

Bachelor's degree

Tools

QA automation tools

Job description

This Quality Assurance Analyst will be responsible for reviewing the Claims Processing Systems for configured benefits and reimbursement methodologies. Experienced candidates must demonstrate working understanding of claims processing systems and working knowledge of the health care industry.

Scope of Role & Responsibilities

• Create Test Scenarios and Test Cases based on requirements
• QA Benefit and Provider Contract Configuration changes in claim systems to meet requirements and business needs
• Create UB04 and CMS 1500 test claims aligning to requirements
• Meet with business areas to gather business rules and requirements
• Meet with Core configuration team to resolve defects
• Create and maintain documents related to QA
• Analyze QA processes and recommend improvements
• Run QA Automation processes
• Perform other QA tasks as needed

Required Education, Training & Professional Experience

• A Baccalaureate Degree from an accredited college or university; and
• Three (3) years of progressive, responsible experience in QA involving test scenario and test case creation; and
• Working knowledge of claims both UB04 and CMS1500; and
• Working knowledge and expertise in IT applications and systems analysis methodology; and
• Working knowledge of Managed Health Care MIS Systems; and
• Working knowledge of QA automation tools; or
• A satisfactory equivalent combination of training, education, and experience

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Excellent verbal and written communication skills.
• Excellent analytical ability.
• Excellent interpersonal, customer service and time management skills.

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