Test Lead - Healthcare Payer Testing

HealthEdge; United States; Remote; USD 100,000 - 120,000; Full time

Job summary

HealthEdge is seeking a Test Lead with healthcare payer domain expertise to drive test planning and execution for payer system engagements. This role is hands-on — you own test case design, defect management, and daily execution quality while collaborating with the Test Manager and cross-functional delivery teams.

Location: Remote, United States. You will lead testing of claims processing, enrollment, benefits, and provider data, coordinate EDI transactions, and support compliance tests across

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).
• 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 payer modules (claims, enrollment, benefits).
• Lead functional, integration, regression, and UAT cycles.
• Analyze requirements and identify gaps and testability issues before execution.
• Own defect lifecycle management from logging to closure.
• Validate EDI transactions (834, 837, 835, 270/271, 820) against rules and standards.
• Coordinate with developers, BAs, and config teams to resolve blockers.
• Produce daily/weekly status reports with defect metrics and risk flags.
• Manage offshore QA analysts.

Skills

QA Testing

Lead Experience

Healthcare Payer Testing

EDI X12

HIPAA Compliance

Test Design Techniques

Defect Tracking Tools

Payer Business Rules

Attention to Detail

Tools

JIRA

Zephyr

ALM

Job description

Overview

We can only consider US Citizens or Green Card holders for this position at this time.

Test Lead — Healthcare Payer Testing

Location: Remote

Employment Type: Full-Time

Role Overview

We are seeking a Test Lead with healthcare payer domain expertise to drive test planning and execution for payer system engagements. This role is hands‑on — you own test case design, defect management, and daily execution quality while collaborating closely with the Test Manager and cross‑functional delivery teams.

Key Responsibilities

Develop detailed test cases, scenarios, and scripts for claims processing, enrollment, benefits, provider data, and EDI transaction flowsLead functional, integration, regression, and UAT cycles for assigned payer modulesAnalyze requirements and business rules — identify gaps, ambiguities, and testability issues before execution startsOwn defect lifecycle management: logging, triage, root cause classification, retest, and closure trackingValidate EDI transactions (834, 837, 835, 270/271, 820) against payer business rules and X12 standardsSupport compliance and regulatory test cycles — ICD updates, CMS mandates, state-specific Medicaid rulesCoordinate with developers, BAs, and configuration teams to resolve blockers and clarify expected behaviorProduce daily/weekly execution status reports with defect metrics, coverage status, and risk flagsManages offshore QA analysts.

Required 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 experience 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 and interpret payer business rules, EOPs, benefit plan documents, and SLAs
• Strong attention to detail — payer system defects have financial and compliance consequences

Geographic Responsibility:

Remote, US

Type of Employment:

Full-time, permanent

FLSA Classification (USA Only):

Exempt

Work Environment:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

• The employeeis occasionally required tomove around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

• Work across multiple time zones in a hybrid or remote work environment.

• Long periodsof time sitting and/or standing in front of a computer using video technology.

• May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skillsrequired. HealthEdge reserves the right tomodify, add, or remove duties and to assign otherdutiesas necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990.Candidates maybe requiredto go through a pre-employment criminal background check.

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women,veteransand persons with disabilities.

#LI-Remote

The annual US base salary range for this position is $100,000 to $120,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will bedeterminedduring the interview process and is based on a combination of factors including, but not limited to,your skills, experience,qualificationsand education.