Experienced Test Manager – PBM

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee comprehensive pharmacy testing from start to finish, encompassing SIT, UAT, Regression, and Parallel Testing for F6 transaction formats.

• Create and manage test strategies, plans, schedules, and execution governance.

• Ensure compliance with regulatory timelines and state Medicaid requirements.

• Validate and enforce NCPDP F6 transaction routing, data crosswalks, expanded product identifiers, and telephony compliance.

• Assist in the transition from D.0 to F6 for 271 Eligibility Response and Formulary and Benefit outbound extracts.

• Supervise pharmacy functional validation activities, including claims adjudication, drug pricing, formulary management, prior authorization, DUR, COB, rebates, and pharmacy financial reconciliation.

• Manage defects and facilitate cross-functional collaboration among business SMEs, PBMs, switch networks, vendors, developers, conversion teams, and both onshore and offshore testing resources.

• Deliver leadership reporting and maintain sponsor-facing communication with stakeholders by monitoring quality metrics, risks, issues, and test progress.

⛳️ Requirements

• A minimum of 10 years in software testing.

• At least 5 years of experience in Test Management.

• Strong background in PBM or Medicaid pharmacy operations.

• Direct experience with NCPDP standards transitions (D.0, F2, or F6).

• Familiarity with large-scale DDI or MMIS modernization initiatives.

• Proficiency in claims adjudication, NCPDP transactions, Prior Authorization, Formulary management, Drug Rebate processing, Eligibility (270/271) processing, and pharmacy financial validation.

• Experience utilizing ALM/JIRA and SQL for data validation tasks.

• Excellent leadership, communication, and stakeholder management abilities.

• Fully remote work is restricted to locations within the Contiguous US.

• Video cameras are required during all interviews and the initial week of orientation.

🏝️ Benefits

• Flexible work arrangements.

• Opportunities for learning and career advancement.

• Flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.