Cincinnati OH
Job Description:
>> Strong SME knowledge in Healthcare Claims Processing lifecycle
>> Expertise in EDI formats 837 (PID), 835, 834
>> Hands-on experience in Facets (Claims + Enrollment modules)
>> Proficiency in Azure DevOps (ADO) for QA tracking
>> Knowledge of HIPAA compliance and payer systems
>> 8+ years of experience in Healthcare QATesting
>> 4+ years of experience as Test Lead in Facets projects
>> Deep understanding of Claims Adjudication & Payment workflows
>> Experience in handling claims denials, adjustments, and reprocessing
>> Strong exposure to EDI claim and remittance transactions
>> Experience in mocking and validating EDI files (837835834)
>> Knowledge of ITS claims processing (SF, DF, RF)
>> Experience in Member Enrollment workflows (Medicaid, Medicare, ACA)
>> Understanding of Billing lifecycle for member enrollment
>> Hands-on experience with ADO Test Plans, Test Suites, and Defect tracking
>> Ability to perform data validation and reconciliation activities
>> Strong experience in functional and end-to-end testing Familiarity with AgileScrum methodologies
>> Excellent stakeholder communication and coordination skills
>> Experience in risk identification, defect triage, and RCA
Requirements:
>> Lead end-to-end testing for Claims, Enrollment, and Billing modules
>> Act as SME for Claims Processing and EDI transactions
>> Design and execute test strategies, test plans, and test cases
>> Perform EDI validation (837, 835, 834) including mock data creation
>> Manage defect lifecycle, triage, and resolution tracking in ADO
>> Ensure HIPAA compliance in all testing activities
>> Validate ITS claims processing across SF, DF, RF flows
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