QA Analyst – EDIFECS
Healthcare EDI & Core Admin Platform
Location: Remote
Experience: 8–10 years
Tech Stack: Edifecs (SpecBuilder, XEngine, Transaction/EDI Gateway, Encounter Management), QA Tools (JIRA, ALM, Postman, SoapUI), MongoDB, PostgreSQL, Oracle, X12 EDI (270/271, 834, 835/837, 275, 276/277), AI-Assisted Testing
Role Overview
We are looking for a detail-oriented and analytically strong Lead QA Analyst with hands-on EDIFECS experience to validate, test, and quality-assure the EDI integration layer of our large healthcare core administration platform. This is an execution-focused, hands-on role: you will design and execute test plans for trading partner configurations, transaction maps, and validation rules; validate HIPAA X12 EDI transaction flows end-to-end; and provide day-to-day QA support for high-volume EDI transaction processing — working under the direction of the onsite Lead EDIFECS Analyst and QA Lead.
Key Responsibilities
· Design, develop, and execute comprehensive test plans and test cases for EDIFECS trading partner configurations, transaction maps, and validation rules covering X12 transactions (270/271, 834, 835/837, 275, 276/277).
· Perform functional, regression, integration, and end-to-end testing of EDIFECS configurations and EDI transaction flows across development, UAT, and production-support environments.
· Validate inbound and outbound EDI transaction processing — including segment-level and element-level compliance against HIPAA X12 implementation guides and payer companion guides.
· Test and certify trading partner onboarding configurations, including acknowledgment flows (999, 997, TA1, 277CA) and connectivity validation (AS2, SFTP).
· Identify, document, and track defects using JIRA or equivalent tools; work closely with the EDIFECS development and configuration team to facilitate timely resolution.
· Collaborate with the onsite lead and client stakeholders on requirements clarification and design validation
· Validate SpecBuilder specs, maps, and custom validation/business rules against defined requirements and companion guide standards.
· Perform database validation across MongoDB, PostgreSQL, and Oracle to verify EDI transaction data integrity at the persistence layer.
· Support production defect triage and troubleshooting — analyzing transaction failures and rejections, identifying root causes, and validating fixes.
· Create and maintain QA documentation including test plans, test cases, traceability matrices, and defect reports.
· Collaborate with the onsite lead, EDIFECS configuration team, and client stakeholders on requirements clarification, test scope definition, and sign-off.
· Participate in configuration and code reviews from a quality and testability perspective.
· Support broader platform modernization and regression testing initiatives by providing EDI/EDIFECS QA subject matter expertise.
Required Qualifications
· Bachelor's degree in Computer Science, Engineering, Health Informatics, or a related field.
· 8-10 years of experience in healthcare EDI/integration QA, with strong hands-on experience testing EDIFECS configurations (SpecBuilder, XEngine, Transaction/EDI Gateway).
· Strong working knowledge of core HIPAA X12 EDI transactions: 270/271, 834, 835/837, 275, and 276/277 — including segment and element-level validation.
· Demonstrated ability to write detailed test plans, test cases, and traceability matrices for EDI/integration testing.
· Experience validating trading partner onboarding flows, acknowledgment handling (999/997/TA1/277CA), and connectivity channels (AS2, SFTP).
· Hands-on experience with defect management and test management tools (JIRA, HP ALM, or equivalent).
· Ability to query and validate data in MongoDB, PostgreSQL, and Oracle databases to verify backend EDI transaction integrity.
· Experience with API/EDI testing tools such as Postman, SoapUI, or similar for validating transaction payloads.
· Strong analytical and debugging skills for diagnosing EDI transaction failures and rejections in high-volume production environments.
· Good written and verbal communication skills for collaborating with onsite leads, developers, and client stakeholders.
AI Knowledge & AI-Assisted Testing (Required)
· Daily, practical use of AI coding/assistant tools to accelerate EDIFECS test case generation, test data creation, and defect analysis.
· Able to critically review and validate AI-generated test cases, assertions, and configurations for correctness before execution.
· Understanding of secure and compliant AI tool usage, including never entering PHI, member data, or other sensitive information into prompts or external AI tools.
· Able to identify where AI-driven automation can improve day-to-day EDI testing, regression coverage, or defect triage efficiency.
Preferred Qualifications
· Experience with health plan/payer core administration systems (e.g., Facets, QNXT, HealthRules) from a QA/testing perspective.
· Familiarity with CAQH CORE operating rules and their testing implications.
· Exposure to automated testing frameworks applicable to EDI/integration testing pipelines.
· Experience with mainframe or cloud-based integration patterns supporting EDI processing.
· Relevant certifications: EDIFECS product certifications, ISTQB, or equivalent QA certifications.
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