QA. PBM jobs in Remote

QA Lead/Manager- PBM Claims Processing -Remote

Remote

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5d ago

Required Qualifications 15+ years of software quality assurance experience, including hands-on test design and execution.5+ years of QA leadership or management experience.Strong experience supporting PBM claims processing systems.Deep understanding of SDLC, Agile execution, test estimation, risk-based testing, and release management.Ability to define and manage quality metrics, dashboards, and team performance indicators.Strong analytical, communication, stakeholder management, and problem-solv

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Contract, Third Party

$62

PBM and Pharmacy Claims QA Tester (7+ years of Experience required)

Remote

•

2d ago

Job Description: Job Title: QA Tester (Pharmacy claims and PBM testing experience) Location: Remote Type: Full Time/W2 with Infinite Computer Solutions Job Description: We re looking for a Test Engineer with strong pharmacy claims and PBM testing experience to support an NCPDP D.0 to F6 implementation. This role is responsible for validating transaction changes, claim adjudication outcomes, eligibility and coordination of benefits scenarios, reject messaging, payer sheet impacts, data mapping, r

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Full-time

$70,000 - $85,000

Pharmacy Claims & PBM Domain Tester - Remote

Remote

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2d ago

Job Details: Pharmacy Claims & PBM Domain Testing NCPDP D.0 / F6 Standards & Migration Validation Claim Adjudication, Eligibility, COB, Pricing & Reject Messaging Test Planning, Test Cases, Test Scripts, Traceability & Test Data Functional, SIT, UAT, Regression, Integration, E2E, Parallel, Release & Production Validation SQL, Backend Data Validation, Reconciliation & Claims Data Analysis Payer Sheet, Field Mapping, Business Rules & Transaction Specification Analysis Defect Manage

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Contract, Third Party

Depends on Experience

Product Owner - Healthcare, PBM

Hybrid in Plano, Texas

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13d ago

Role : Product OwnerLocation : Plano, Texas - Hybrid Job Description Agile Product Management serves as the internal voice of the customer.Defines system features and participates in validation.Responsible for the scope of work that the Agile Release Train (ART) will complete, and the vision and roadmap for the Agile Release Train (ART).Must be aware of other work being completed within the Portfolio so that they can help teams proactively manage risks and dependencies.The incumbent provides exp

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Contract

Depends on Experience

Business Analyst With Pharmacy Benefit Management - Remote

Remote

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3d ago

We are looking to onboard a Senior Business Analyst in Manager role or Individual contributor depending on experience level. This person will have deep PBM domain expertise and who will help guide the roadmap and feature enhancements for the Client PBM product suite. This person will serve as a bridge between the Business users and/or Clinical end users (Pharmacists) and the Technical team (Developers and Testers primarily). Minimum Qualifications: EXPERIENCE LEVEL: Ideally 10+ years experience

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Contract, Third Party

$55

Principal Solution Architect Pharmacy/PBM

Remote

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2d ago

Company Description Lumen SolutionsGroupInc. is a technology consulting Services company based inFlorida. Weprovidea wide array of experienced business and IT professionals supporting clients from solution design to implementation and support.We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, EnterpriseTransformation. Position: Principal Solution Architect Pharmacy/PBM Type: 6 months Contract-to-Hire Lo

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Contract

Depends on Experience

Healthcare Payer PBM Business Architect

Remote

•

2d ago

Hiring! Healthcare Payer and PBM Operations Architect - for a contract to hire job opportunity with our direct client. Though this is a 100% remote based job opportunity, we are seeking candidates that are located in the DMV, WVA, PA, NY, NJ or Texas areas. Candidates must be eligible for full time employment and work on a W2 basis. Job requirement: Proficiency in innovating ideas and solutions resulting in tangible and measurable business outcomes.Mastery in creating architecture solutions w

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Contract

Depends on Experience

Senior Synon & Cobol400 Developer

Remote

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5d ago

Role: Senior Synon & Cobol400 Developer Location: Remote Job Description * Design, develop, modify, and enhance applications using SYNON/COOL 2E, COBOL400, CL/400, CLLE, and DB2/400. * Develop and support RxCLAIM / pharmacy claims adjudication functionality and related business processes. * Analyze and enhance complex claim processing logic, including business rules and system workflows. * Develop and maintain integrations with downstream healthcare and PBM systems. * Perform major enhancements

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Third Party, Contract

Depends on Experience

Solution Architect (PBM)

Remote

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5d ago

100% remote role but need to come onsite once in every 3 months. (expenses will be paid for the travel) What the role will involve: The resource will be working with other domain architects and the PBM provided. Will be working on the architecture on how the PBM provider integrated back in the CareFirst systems. Must haves: Looking for resources will solid solution architecture in the PBM space. Must have 10+ years Solution Architecture experience with around 10 years of PBM experience. Solid PB

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Contract

Depends on Experience

Quality Business Area Manager

Huntsville, Alabama

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Today

Description The Defense sector at Leidos has an opening for a Quality Business Area Manager Role! Daily duties and/or specific job responsibilities. Establish and maintain a quality culture committed to performance excellence, customer mission, and Leidos values/requirements.Plan and manage quality engineering & control activities to support Sr Program Quality Manager and business area initiatives to achieve mission assurance and program performance excellence.Support the development, deploymen

Full-time

USD 116,350.00 - 210,325.00 per year

QA Test Engineer - Pharma, Remote - 69790

Remote

•

Today

QA Test Engineer - Pharma, Remote We have an immediate need for an experienced Senior QA Test Engineer with strong expertise in Pharmacy Claims, PBM systems, healthcare transaction processing, and end-to-end testing to design, execute, and support comprehensive testing initiatives for complex claims adjudication platforms. This is a remote position based in Florham Park, NJ, for a candidate with deep experience in Pharmacy Claims & PBM Domain Testing, NCPDP D.0/F6 Standards, Claims Adjudic

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Contract

$40.00 - 42.00

Contract role: Sr QA Test Engineer (Pharma Claims) at Florham Park, NJ (Remote)

Remote or New Jersey

•

Today

Sr QA Test Engineer Florham Park, NJ (Remote) Long Term Contract Job Details: Pharmacy Claims & PBM Domain Testing NCPDP D.0 / F6 Standards & Migration Validation Claim Adjudication, Eligibility, COB, Pricing & Reject Messaging Test Planning, Test Cases, Test Scripts, Traceability & Test Data Functional, SIT, UAT, Regression, Integration, E2E, Parallel, Release & Production Validation SQL, Backend Data Validation, Reconciliation & Claims Data Analysis Payer Sheet, Field Mapping, Business Rules

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Contract

Lead Director AI Platform Enablement Automation

Northbrook, Illinois

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Today

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health , you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time. Position Summary The Lead Director - AI Platform Enablem

Full-time

USD 144,200.00 - 288,400.00 per year

Senior Network Pricing Consultant

Eden Prairie, Minnesota

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Today

Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us ad

Full-time

USD 60,200.00 - 107,400.00 per year

Senior Technology Project Manager

Irvine, California

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Today

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health op

Full-time

USD 91,700.00 - 163,700.00 per year

Analyst III, Network Configuration

Remote

•

Today

Company Navitus About Us Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and eac

Full-time

USD 54,236.00 - 64,567.00 per year

Synon Developer

Remote

•

3d ago

Role : Senior Synon DeveloperLocation : Remote Job Description Design, develop, modify, and enhance applications using SYNON/COOL 2E, COBOL400, CL/400, CLLE, and DB2/400.Develop and support RxCLAIM / pharmacy claims adjudication functionality and related business processes.Analyze and enhance complex claim processing logic, including business rules and system workflows.Develop and maintain integrations with downstream healthcare and PBM systems.Perform major enhancements and modifications to ex

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Contract

Depends on Experience

Senior Synon & Cobol400 Developer

Remote

•

2d ago

Hi, Please find the job description below Role: Senior Synon & Cobol400 Developer Location: Remote Job Description Design, develop, modify, and enhance applications using SYNON/COOL 2E, COBOL400, CL/400, CLLE, and DB2/400. Develop and support RxCLAIM / pharmacy claims adjudication functionality and related business processes. Analyze and enhance complex claim processing logic, including business rules and system workflows. Develop and maintain integrations with downstream healthcare

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Third Party, Contract

Depends on Experience

ITX Developer (IBM Transformation Extender) Healthcare EDI

Remote

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24d ago

ITX Developer (IBM Transformation Extender) Healthcare EDILocation: Remote (USA) Job Type: Contract / Long-Term Job SummaryWe are seeking an experienced IBM ITX (IBM Transformation Extender) Developer with strong expertise in Healthcare EDI and NCPDP transactions to join our integration team. The ideal candidate will have hands-on experience developing and maintaining ITX maps, implementing HIPAA-compliant EDI solutions, and working with healthcare transaction standards. This role requires both

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Full-time

Depends on Experience

Pharma Business Analyst

Teaneck, New Jersey

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3d ago

Business Analyst with Pharmacist ExperienceLocation: Hackensack, NJ Work Model: 100% Onsite (5 Days a Week) Experience: 38 Years Schedule: Monday Friday (Onsite) Work Model: 100% Onsite (5 Days a Week) Job SummaryWe are seeking a Pharma Business Analyst with a strong pharmaceutical background and experience translating business requirements into technology solutions. The ideal candidate will possess a Bachelors or Doctorate degree in Pharmacy and have hands-on experience working as a Pharmacist

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Contract

Depends on Experience