Manager, IT Testing – Claims Domain

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

📋 Description

• Act as the Claims Domain Test Manager for MMIS health care initiatives.

• Lead the development of test strategies, processes, and expertise in the claims domain.

• Evaluate business requirements and create comprehensive test plans.

• Maintain quality assurance practices throughout the project lifecycle.

• Collaborate with clients on project delivery and deployments.

• Offer testing guidance throughout all stages of the project lifecycle.

• Meet client expectations and resolve application issues.

• Assist clients in making implementation decisions.

• Work closely with clients and development teams during the development phase.

• Conduct milestone completion demonstrations and manage feedback from demos.

• Partner with development, architecture, and design teams to establish GUI views and platform requirements.

• Confirm the end-to-end process from claim intake to payment and reporting.

• Test integration points between various systems.

• Develop test cases based on business rules, coverage policies, and system settings.

• Validate backend data using SQL, including claims status, payment information, members, providers, and benefit plans.

• Validate EDI X12 files and test interfaces/APIs utilizing tools such as Postman.

• Review requirements and documentation to create Requirements Traceability Matrices.

• Formulate test plans, test summary reports, and traceability matrices.

• Evaluate current product functionality against market trends and regulatory requirements for future product iterations.

• Drive and communicate product feature requirements with technical and architecture teams.

• Collaborate with cross-functional teams, including developers, SMEs, and BAs.

⛳️ Requirements

• Extensive health care domain experience, particularly in the MMIS domain.

• Strong knowledge of Medicaid and Medicare.

• Practical experience with claims processing and adjudication procedures.

• Familiarity with reference codes/data sets required for claims adjudication.

• Experience or understanding of configuring benefits or programs in claims systems across different subsystems.

• Ability to run queries and conduct basic system analysis and root-cause analysis (RCA).

• Exceptional written and verbal communication skills.

• Capability to multitask between internal teams and clients based on priority assignments.

• Comprehensive understanding of claims and the claims lifecycle, including member, provider, paper and EDI X12 claim submission, adjudication, payment cycle, and reporting.

• Knowledge of various claim types, including professional, dental, institutional, pharmacy, encounter, and capitation claims.

• Familiarity with EDI X12 formats such as 837P/I/D, 835, 834, 270/271, and 276/277.

• Experience with claims systems like CMdS, GHS, and Facets.

• Knowledge of test management tools such as ADO and JIRA.

• Familiarity with interface/API testing tools such as Postman.

• Minimum of 10+ years of health care experience, especially in the MMIS domain.

• Proficient in SQL for backend data validation.

• Familiar with EDI tools for validating X12 files.

• Understanding of data flows between systems and formats necessary for interface testing.

• Ability to validate test scenarios, test plans, and test data.

• Capable of reviewing requirements and documentation to create Requirements Traceability Matrices (RTM).

• Ability to assess product functionality against market trends and regulatory requirements.

• Competence in driving and communicating requirements with technical and architecture teams.

• Experience in creating test plans, test summary reports, and traceability matrices.

• Ability to work collaboratively with developers, SMEs, BAs, QA teams, clients, end users, and business units.

🏝️ Benefits

• Eligibility for bonuses or incentives based on business needs.

• Coverage for health insurance.

• Optional dental and vision insurance programs.

• Life and disability insurance coverage.

• Retirement savings plan.

• Paid holidays.

• Paid time off (PTO) or vacation and/or sick leave.

• Reasonable accommodations for applicants with disabilities.