Remote Healthcare Payer QA Lead II

Wellframe; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

HealthEdge is seeking a Test Lead II with healthcare payer domain expertise to drive test planning and execution for payer system engagements. This hands‑on role leads test design, defect management, and daily execution quality while coordinating with the Test Manager and cross‑functional teams.

You will develop detailed test cases for claims processing, enrollment, benefits, and EDI flows, lead various test cycles, and ensure regulatory testing compliance.

Qualifications

• 5+ years in software QA/testing.
• 2+ years in a lead or senior tester role.
• Solid experience testing U.S. healthcare payer systems — claims, enrollment, benefits, or provider network.
• Working knowledge of EDI X12 transactions and HIPAA compliance requirements.
• Hands‑on test case design using boundary analysis, equivalence partitioning, and negative testing techniques.
• Proficiency in defect tracking and test management tools (JIRA, Zephyr, ALM, or equivalent).
• Ability to read payer business rules, EOPs, benefit plan documents, and SLAs.
• Strong attention to detail — payer system defects have financial and compliance consequences.

Responsibilities

• Develop detailed test cases, scenarios, and scripts for claims processing, enrollment, benefits, provider data, and EDI flows.
• Lead functional, integration, regression, and UAT cycles for assigned payer modules.
• Analyze requirements and business rules; identify gaps and ambiguities before execution.
• Own defect lifecycle management: logging, triage, root cause classification, retest, and closure.
• Validate EDI transactions against payer business rules and X12 standards.
• Support compliance and regulatory test cycles — ICD updates, CMS mandates, state Medicaid rules.
• Coordinate with developers, BAs, and configuration teams to resolve blockers.
• Produce daily/weekly execution status reports with defect metrics and risk flags.
• Manage offshore QA analysts.

Skills

QA testing

Lead role

Healthcare payer domain

EDI testing

Defect tracking

Test design

Tools

JIRA

Zephyr

ALM

Job description

HealthEdge is seeking a Test Lead II with healthcare payer domain expertise to drive test planning and execution for payer system engagements. This hands‑on role leads test design, defect management, and daily execution quality while coordinating with the Test Manager and cross‑functional teams.

You will develop detailed test cases for claims processing, enrollment, benefits, and EDI flows, lead various test cycles, and ensure regulatory testing compliance.