QA Analyst – EDIFECS
Healthcare EDI & Core Admin Platform
Location: Remote
Experience: 5–7 years
Full-Time
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 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.
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.
5–7 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.
