Claims Tester Jobs (NOW HIRING)

This is a 4-month engagement. It's a fully remote position; candidates must be available to work Pacific Time (PST) hours. Senior Test / QA Analyst needed to support a West Coast healthcare client in a fast-paced payer environment. Seeking candidates with strong experience in health plan claims testing, including medical claims adjudication, HIPAA EDI transaction testing (837/835/270/271), SQL validation, and end-to-end QA processes. Ideal candidates will have experience working with core claims administration platforms such as FACETS, QNXT, ika, PCM, or similar systems. Strong knowledge of healthcare claims workflows, payer operations, and QA best practices is highly preferred.

Location: Fully Remote (Must be available to work Pacific Time hours)

Description:

Impresiv Health is seeking an experienced Senior Test / QA Analyst to support a West Coast healthcare client in a 4-month engagement focused on health plan claims processing systems. This role requires deep expertise in healthcare claims adjudication, EDI transaction testing, regulatory compliance, and enterprise quality assurance methodologies. The ideal candidate is highly analytical, detail-oriented, and experienced leading testing efforts across complex payer environments involving medical, pharmacy, and dental/vision claims.

What You Will Do:

• Design, develop, and execute comprehensive test strategies, test plans, test cases, and test scripts for health plan claims processing systems.
• Validate end-to-end claims adjudication workflows including intake, pricing, benefit application, coordination of benefits (COB), payment processing, and EOB generation.
• Perform testing and validation of HIPAA-compliant EDI transaction sets including 837, 835, 270/271, 276/277, and 834 transactions.
• Verify claims payment accuracy against fee schedules, contracted provider rates, DRG/APR-DRG methodologies, per diem structures, and MAC pricing logic.
• Test auto-adjudication workflows, prior authorization integrations, manual review queues, and claims editing logic.
• Lead defect management activities including defect triage, root cause analysis, regression testing, and release validation.
• Partner with business analysts, claims operations teams, developers, and external trading partners to translate requirements into testable scenarios.
• Produce detailed test documentation including defect reports, traceability matrices, test summaries, and QA metrics dashboards.
• Support UAT coordination and release readiness activities across Agile and waterfall project environments.
• Ensure compliance with ACA, CMS, NCQA, HIPAA, state DOI mandates, and other applicable healthcare regulations.
• Validate code set updates including ICD-10-CM/PCS, CPT, HCPCS, NDC, and revenue code table refreshes.
• Mentor junior QA analysts and contribute to QA standards, frameworks, and best practices.

You Will Be Successful If:

• Possess deep functional knowledge of healthcare claims adjudication and payer operations.
• Demonstrate confidence validating complex claims processing workflows and EDI transaction pipelines with high accuracy.
• Thrive in fast-paced environments managing multiple testing priorities across release cycles.
• Communicate effectively with both technical and operational stakeholders.
• Maintain strong attention to detail while proactively identifying risks, defects, and process improvement opportunities.
• Bring a solid understanding of healthcare compliance and regulatory testing requirements.
• Successfully lead testing initiatives independently while collaborating cross-functionally within Agile teams.

What You Will Bring:

• 5 years of QA/testing experience, including at least 3 years supporting health plan claims processing systems.
• Strong experience with medical claims adjudication including COB, subrogation, remittance processing, and claims editing platforms such as ClaimLogic, ClaimsXten, or similar tools.
• Hands-on experience testing HIPAA EDI transactions including 837P/837I, 835, 276/277, and 270/271 transactions.
• Proficiency with SQL for test data validation and backend verification activities.
• Experience with health plan core administration platforms such as TriZetto FACETS, QNXT, ika, PCM, or similar systems.
• Experience working within Agile/Scrum environments utilizing Jira, Azure DevOps, Rally, or similar tools.
• Strong understanding of ICD-10, CPT/HCPCS coding structures, modifier logic, and revenue codes.
• Excellent analytical, troubleshooting, documentation, and communication skills.
• Experience with pharmacy claims testing, Medicare Advantage claims processing, or PBM integrations is preferred.
• Familiarity with test automation and API testing tools including Selenium, Postman, and SOAP UI is a plus.
• QA certifications such as ISTQB or CSTP are preferred.
• Bachelor?s degree in Computer Science, Information Systems, Healthcare Administration, or related field; equivalent experience considered.