Job Title: QA/Testing Engineer (Healthcare)
Duration: 06 Months (Contract to Hire) (W2 Contract Only)
Location: Remote
Technical Must Haves
· Must have 5+ years of hands-on Healthcare QA/Testing experience with a strong focus on MMIS (Medicaid Management Information System) projects.
· Must have extensive hands-on Claims Testing experience across the complete healthcare claims lifecycle.
· Must have strong Healthcare domain knowledge with expertise in both Medicaid and Medicare.
· Must have hands-on experience with Claims Processing and Claims Adjudication.
· Must have strong understanding of claims reference codes, reference data sets, and business rules required for claims adjudication.
· Must have experience configuring benefits, programs, and claims system setup across multiple claim processing subsystems.
· Must have strong SQL skills to validate backend data, claims status, payment information, members, providers, and benefit plans.
· Must have experience performing system analysis, root cause analysis (RCA), and defect validation.
· Must have experience validating end-to-end claims processing from claim intake through adjudication, payment, and reporting.
· Must have experience testing Professional, Institutional, Dental, Pharmacy, Encounter, and Capitation claims.
· Must have experience working with EDI X12 transactions including 837P, 837I, 837D, 835, 834, 270/271, and 276/277.
· Must have experience validating EDI transactions using EDI validation tools.
· Must have experience with Interface Testing and API Testing using Postman or similar tools.
· Must have experience creating test strategies, test plans, test cases, test scenarios, test data, and test summary reports.
· Must have experience preparing and maintaining Requirements Traceability Matrix (RTM).
· Must have experience using test management tools such as Azure DevOps (ADO), JIRA, or equivalent.
· Must have experience working with claims processing platforms such as Facets, CMdS, GHS, or similar healthcare claims systems.
· Must have experience collaborating with Development, Architecture, Business Analysts, SMEs, and client teams throughout the SDLC.
· Must have experience participating in client demonstrations, validating milestones, tracking feedback, and supporting production implementations.
· Must have strong written and verbal communication skills with the ability to manage multiple priorities and work directly with clients.
Desired
· Desired experience working on large-scale Medicaid MMIS modernization or implementation projects.
· Desired experience with healthcare benefit configuration and policy validation.
· Desired experience assessing regulatory requirements and validating compliance changes within healthcare claims systems.
· Desired experience supporting GUI validation and application design reviews.
· Desired experience performing integration testing across multiple healthcare systems and interfaces.
· Desired experience creating innovative testing approaches and improving QA processes.
· Desired experience working in Agile or hybrid software development environments.
· Desired ability to provide testing guidance throughout the full software development lifecycle.
· Desired experience supporting production deployments, release validation, and post-implementation testing.
· Desired experience working closely with cross-functional business and technical stakeholders to deliver high-quality healthcare solutions.