"Role Summary
Seeking a Senior QA Engineer with strong Medicaid payer and Facets expertise to independently validate state-specific regulatory implementations across Facets, Mainframe, Java, DataStage, Talend/TalendWorks, and associated applications.
Key Responsibilities
Analyze Medicaid regulatory requirements and develop comprehensive test scenarios for individual states.
Validate end-to-end changes across:
o Facets
o Mainframe
o Java applications
o DataStage
o Talend/TalendWorks
o APIs/interfaces
o Batch systems
o Upstream/downstream applications
Test regulatory changes involving member enrollment, eligibility, benefits, claims adjudication, pricing, edits, and payments.
Validate Mainframe and Java batch/interface processing.
Perform ETL and source-to-target data validation.
Conduct functional, integration, end-to-end, regression, negative, and boundary testing.
Perform independent quality assessments of regulatory solutions.
Identify gaps between regulatory requirements, requirements documentation, technical implementation, and actual system behavior.
Perform SQL-based data validation and reconciliation.
Conduct defect analysis and support root-cause investigation.
Ensure traceability across Regulation Business Requirement System Change Test Scenario Test Result.
Required Experience
Strong healthcare payer QA/testing experience.
Strong testing knowledge of TriZetto Facets.
Testing experience across Mainframe and Java-based applications.
Experience validating DataStage and Talend/TalendWorks processes.
SQL and database testing skills.
Strong Medicaid managed-care knowledge.
Experience with state-specific Medicaid requirements.
Good Medicare and Medicaid health-plan knowledge.
Strong understanding of:
o Member enrollment
o Eligibility
o Benefits
o Claims
o Claims adjudication
o Pricing
o Payment
Experience performing quality assessments for complex regulatory implementations.
