Role : Sr. QA/Tester with Healthcare claims
Location : Dallas, TX, St Louis, MO, Las vegas, NV Hybrid
Required Skills & Experience
5 7 years of experience in Healthcare IT, Medicaid, or PBM environments.
Strong understanding of claims adjudication, prior authorization, and pharmacy benefit processes.
Hands-on experience with Power BI (data modeling, DAX, dashboards).
Experience with SQL for data validation and analysis.
Familiarity with MMIS, PBM systems, or healthcare portals.
Strong documentation skills (BRD, FRD, test cases, process flows).
Experience in Agile/Scrum environments.
Preferred Qualifications:
Experience with Medicaid or Medicare programs.
Knowledge of clinical guidelines (e.g., InterQual, MCG).
Exposure to automation testing tools (optional).
Understanding of HIPAA, CMS regulations, and healthcare compliance.
Required Skills & Experience:
- 5 7 years of experience in Healthcare IT, Medicaid, or PBM environments.
- Strong understanding of claims adjudication, prior authorization, and pharmacy benefit processes.
- Hands-on experience with Power BI (data modeling, DAX, dashboards).
- Experience with SQL for data validation and analysis.
- Familiarity with MMIS, PBM systems, or healthcare portals.
- Strong documentation skills (BRD, FRD, test cases, process flows).
- Experience in Agile/Scrum environments.
- Preferred Qualifications:
- Experience with Medicaid or Medicare programs.
- Knowledge of clinical guidelines (e.g., InterQual, MCG).
- Exposure to automation testing tools (optional).
- Understanding of HIPAA, CMS regulations, and healthcare compliance.
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