HJ Staffing
Senior Test / QA Analyst
Vaga remota de QA Analyst com fit claro de localização do candidato.
Publicada14 de jun. de 2026
Países elegíveis1 país aceito
Sinal de senioridadeSenior
Modelo de trabalhoRemoto
Locais aceitos para candidatos
Estados Unidos
Resumo da vaga
Senior Test / QA Analyst
Requisitos e responsabilidades
Conteúdo da vaga extraído em seções para revisão mais rápida.
What You Will Do
- Test Strategy & Execution: Design and execute comprehensive test plans, test cases, and test scripts for health plan claims processing systems.
- Workflow Validation: Validate end-to-end claims adjudication workflows including intake, pricing, benefit application, coordination of benefits (COB), payment processing, and EOB generation.
- EDI & Transaction Testing: Perform robust testing and validation of HIPAA-compliant EDI transaction sets including 837P/837I, 835, 270/271, 276/277, and 834 transactions.
- Financial & Pricing Accuracy: Verify claims payment accuracy against fee schedules, contracted provider rates, DRG/APR-DRG methodologies, per diem structures, and MAC pricing logic.
- System & Core Admin Testing: Test auto-adjudication workflows, prior authorization integrations, manual review queues, and claims editing logic across core platforms.
- Defect Management: Lead defect triage, root cause analysis, regression testing, and release validation.
- Data Validation: Utilize SQL for deep-dive test data validation and backend verification activities.
- Compliance Verification: Ensure strict compliance with ACA, CMS, NCQA, HIPAA, state DOI mandates, and validate code set updates (ICD-10-CM/PCS, CPT, HCPCS, NDC, and revenue code tables).
- Cross-Functional Collaboration: Partner with business analysts, claims operations, developers, and external trading partners to translate requirements into testable scenarios, while mentoring junior QA staff.
Required Experience & Skills:
- Experience: 5+ years of software QA/testing experience, with at least 3 years specifically supporting health plan claims processing systems.
- Claims Adjudication: Strong experience with medical claims adjudication including COB, subrogation, remittance processing, and claims editing platforms (e.g., ClaimLogic, ClaimsXten, or similar tools).
- Core Admin Platforms: Hands-on experience working within health plan core administration platforms such as TriZetto FACETS, QNXT, ika, PCM, or similar systems.
- Technical Tools: Proficiency with SQL for backend validation, alongside experience in Agile/Scrum environments utilizing Jira, Azure DevOps, Rally, or similar project management tools.
- Healthcare Knowledge: Strong understanding of ICD-10, CPT/HCPCS coding structures, modifier logic, and revenue codes.
- Soft Skills: Excellent analytical, troubleshooting, documentation, and communication skills, with the ability to work independently in a fast-paced environment.
Preferred (Nice-to-Have):
- Experience with pharmacy claims testing, Medicare Advantage claims processing, or PBM integrations.
- Familiarity with test automation and API testing tools including Selenium, Postman, and SOAP UI.
- Professional QA certifications such as ISTQB or CSTP.
- Bachelor’s degree in Computer Science, Information Systems, Healthcare Administration, or a related field (equivalent experience will be considered).
Additional Details
- Schedule: Full-time hours, must align with Pacific Standard Time (PST) core working hours.
- Location: 100% Remote (US-based)
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