Healthcare Claims QA Analyst || 12 Phone/Video followed by an Onsite Interview

Healthcare Claims QA Analyst (Manual Testing QNXT) Location: Elkridge, MD (Hybrid Onsite for initial training, then primarily remote with occasional onsite meetings)

Employment Type: Direct Hire (Full-Time)

Interview Process: 1 2 Phone/Video Interviews followed by an Onsite Interview

About the Role

We are seeking an experienced Healthcare Claims QA Analyst to join our client's healthcare technology team supporting the QNXT claims processing platform. This role is heavily focused on manual testing, healthcare claims validation, benefits configuration, and regression testing.

The ideal candidate will have strong experience with QNXT, healthcare claims adjudication, ICD/CPT coding, and manual validation of healthcare claims and benefit configurations. This is not an automation or EDI-focused QA role. Instead, you'll play a critical role in ensuring healthcare claims, member enrollment, provider contracts, and benefits are processed accurately according to business rules and medical coding standards.

Following several weeks of onsite training in Elkridge, MD, this position transitions to a primarily remote schedule with occasional onsite meetings.

Key Responsibilities

• Perform end-to-end manual testing and validation of healthcare claims processing within the QNXT platform.

• Validate upgrades, enhancements, system maintenance, and benefit configuration changes.

• Review healthcare claims, member enrollment, provider contracts, eligibility, authorizations, and payment processing.

• Verify accurate claims adjudication using ICD and CPT coding standards.

• Execute functional, regression, and user acceptance testing for healthcare claims and benefits processing.

• Develop and execute detailed manual test plans, test cases, and testing documentation.

• Collaborate with Business Analysts and IT teams to validate business requirements and identify application defects.

• Document testing results, defects, screenshots, and system behavior while communicating findings to development teams.

• Utilize SQL queries to validate backend data and confirm processing accuracy.

• Review HIPAA transaction files to support claims validation and data integrity.

• Ensure benefit configurations accurately reflect business rules and healthcare policies.

Required Qualifications

• 5+ years of manual QA testing experience within a healthcare environment.

• 3+ years of healthcare claims processing experience.

• Recent hands-on experience with QNXT (Claims, Utilization Management, or Finance modules).

• Strong understanding of healthcare claims adjudication.

• Excellent knowledge of:

  • ICD coding

  • CPT coding

  • Healthcare benefits configuration

• Experience performing manual regression and functional testing.

• Strong SQL skills with the ability to write:

  • Joins

  • Subqueries

  • Unions

• Thorough understanding of:

  • Claims adjudication

  • Member enrollment

  • Eligibility

  • Benefits

  • Authorizations

  • Payment processing

• Experience reviewing HIPAA transaction files including:

  • 278

  • 834

  • 835

  • 837I

  • 837P

  • 837D

• Excellent written and verbal communication skills.

Preferred Qualifications

• Experience with UltraEdit.

• Experience using Claim Test Pro.

• Exposure to automated testing tools or EDI environments is a plus, but manual testing experience is the primary focus.

• Associate degree or relevant healthcare or QA certifications.

Must-Have Skills

Candidates should have experience with all of the following:

• Recent QNXT experience.

• Manual healthcare claims testing.

• Healthcare benefits configuration testing.

• Claims adjudication.

• ICD and CPT coding.

• Manual regression and functional testing.

• SQL querying for backend validation.

• Healthcare claims processing.

What We're Looking For

This role is ideal for someone who understands the business side of healthcare claims-not just software testing.

The successful candidate will be able to confidently discuss:

• Healthcare claims adjudication

• Benefits configuration

• Manual claims validation

• Regression testing

• ICD/CPT code mapping

• QNXT workflows

• Healthcare enrollment and eligibility

• SQL-based data validation

Candidates whose experience is primarily focused on automation testing or EDI testing without strong manual healthcare claims testing experience will not be a fit.

Additional Information

• Must reside within 150 miles of Elkridge, MD.

• Initial onsite training is required before transitioning to a primarily remote work schedule.

• Selected candidates must successfully complete a background check and drug screening.

Benefits

• 3 weeks of paid vacation

• 13 sick days annually

• 11 paid holidays

• Medical insurance (employee pays approximately 15%)

• Employer-paid dental and vision coverage

• Life Insurance and Long-Term Disability (LTD)

• 401(k) with:

  • 50% employer match up to 8%

  • Additional 5% employer contribution through APWU