QA Lead (Rxclaim/PBM)

Remote • Posted 8 hours ago • Updated 8 hours ago
Contract Independent
Contract W2
12 Months
No Travel Required
Remote
Depends on Experience
Fitment

Dice Job Match Score™

🎯 Assessing qualifications...

Job Details

Skills

  • Automated Testing
  • Health Care
  • Pharmacy
  • Benefits Management
  • rxclaim

Summary

Position: - QA Lead (Rxclaim/PBM)
Location: - Remote
Type: - Contract
 
Job Description
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
  • 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
  • Experience testing mainframe and distributed systems
  • 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
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
  • Dice Id: 90769319
  • Position Id: 8976180
  • Posted 8 hours ago
Contact the job poster
YK

Yatin Khatter

Recruiter @ SanKar Inc
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