QA Lead (PBMHealthcare Domain)

Job Title: QA Lead (PBM/Healthcare Domain)

Location: Plano TX

Remote / Hybrid (As per client requirement)

Experience Required

8 Years in Quality Assurance and Healthcare/PBM Domain

Job Summary

We are seeking an experienced QA Lead with strong expertise in Pharmacy Benefit Management (PBM) and Healthcare testing. The ideal candidate will lead quality assurance initiatives across UI API functional integration regression and end-to-end testing efforts while ensuring high-quality delivery of PBM applications and business workflows.

Key Responsibilities

Lead and manage QA activities across PBM/Healthcare projects.
Validate PBM business workflows through functional integration regression and end-to-end testing.
Design and review test strategies test plans test cases and execution reports.
Collaborate with business analysts developers product owners and stakeholders to ensure quality deliverables.
Develop and maintain automation frameworks following modular reusable and scalable design principles.
Perform API UI database and backend validation testing.
Manage defect lifecycle including logging triage tracking retesting and closure.
Ensure comprehensive test coverage and maintain traceability across requirements.
Support release validation and production readiness activities.
Drive quality improvements through automation and AI-driven testing methodologies.

Required Domain Expertise

Strong experience in PBM (Pharmacy Benefit Management) modules including:

Member Eligibility
Benefit Plan Configuration
Formulary Management
Pharmacy POS Claims
Claims Adjudication
Prior Authorization
Utilization Management
Pricing
Accumulators
Pharmacy Networks
Payment & Settlement
Reporting

Technical Skills

API Testing

Postman
SoapUI
Swagger/OpenAPI
REST Assured
Newman

API & Integration Knowledge

REST APIs
SOAP Services
JSON
XML
HTTP Methods
Authentication & Authorization
Response Validation
Status Codes & Error Handling

UI Testing

Web Portal Testing
Browser Validation
Member Provider and Pharmacy Workflows
Admin Portal Testing

Database Testing

SQL Queries
Data Validation
Data Reconciliation
Backend Verification
Reporting Validation

Test Management Tools

Jira
Azure DevOps
ALM/Quality Center
TestRail
qTest

Automation Tools (Preferred)

Selenium
Playwright
Cypress
API Automation Frameworks

Preferred Qualifications

Experience leading QA teams in Healthcare/PBM environments.
Strong understanding of test automation framework design principles.
Experience working in Agile/Scrum environments.
Knowledge of AI-driven testing frameworks and intelligent test automation.
Excellent communication stakeholder management and leadership skills.

Education

Bachelors Degree in Computer Science Information Technology Engineering or a related field.

Preferred Certifications

ISTQB Certification
Certified Scrum Master (CSM)
Healthcare/PBM Domain Certifications