Role: RxCLAIM QA Lead
Location: Remote
Job Description
We are seeking an experienced RxCLAIM QA Lead to lead quality assurance activities for pharmacy benefits management (PBM) systems, with a strong focus on RxCLAIM. The ideal candidate will combine deep domain expertise in pharmacy claims with hands-on QA leadership, ensuring high-quality delivery across complex healthcare platforms.
Key Responsibilities
Lead end-to-end QA activities for RxCLAIM-based applications, including test strategy, planning, execution, and defect management
Act as the QA point of contact for PBM/RxCLAIM initiatives, collaborating closely with business analysts, developers, and product owners
Define and enforce QA processes, standards, and best practices across projects
Review and validate business requirements, functional specifications, and technical designs from a QA perspective
Design and oversee test scenarios, test cases, and test data covering eligibility, claims adjudication, pricing, formularies, benefits, accumulators, and prior authorization
Lead and mentor QA analysts, providing guidance on RxCLAIM workflows and testing techniques
Coordinate SIT, UAT, and regression testing, including support for business and client UAT cycles
Ensure compliance with healthcare regulations and industry standards (HIPAA, CMS, etc.)
Track test execution metrics, defect trends, and quality KPIs; report status to stakeholders
Support automation initiatives by identifying regression candidates and working with automation teams
Participate in release planning, production validation, and post-release defect analysis
Qualifications Required:
8+ years of experience in QA/testing, with at least 3–4 years in a QA Lead role
Strong hands-on experience with RxCLAIM (claims processing, plan setup, pricing, benefits, accumulators, DUR, PA)
Solid understanding of PBM and pharmacy domain concepts
Strong knowledge of test management and defect tracking tools (e.g., ALM, Jira, Zephyr, qTest)
Excellent analytical, problem-solving, and communication skills
Proven experience leading teams and coordinating with cross-functional stakeholders
Preferred Qualifications
Experience with test automation tools and frameworks
Exposure to other PBM platforms (e.g., QNXT, Facets, ICD)
Experience working in Agile/Scrum environments
ISTQB or similar QA certification
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