Senior Test QA Analyst

We are seeking an experienced Senior Test / QA Analyst to support a prominent West Coast healthcare client focused on health plan claims processing systems. This require a high-level QA professional who can hit the ground running in a fast-paced payer environment.

In this role you will leverage your 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 has a proven track record of leading testing efforts across complex payer environments involving medical pharmacy and dental/vision claims.

As a Senior QA Analyst you will design develop and execute comprehensive test strategies while collaborating cross-functionally within Agile teams. Your core responsibilities will include:

• Test Strategy & Execution: Design and execute comprehensive test plans test cases and test scripts for health plan claims processing systems.
• Workflow Validation: Validate end-to-end claims adjudication workflows including intake pricing benefit application coordination of benefits (COB) payment processing and EOB generation.
• EDI & Transaction Testing: Perform robust testing and validation of HIPAA-compliant EDI transaction sets including 837P/837I 835 270/271 276/277 and 834 transactions.
• Financial & Pricing Accuracy: Verify claims payment accuracy against fee schedules contracted provider rates DRG/APR-DRG methodologies per diem structures and MAC pricing logic.
• System & Core Admin Testing: Test auto-adjudication workflows prior authorization integrations manual review queues and claims editing logic across core platforms.
• Defect Management: Lead defect triage root cause analysis regression testing and release validation.
• Data Validation: Utilize SQL for deep-dive test data validation and backend verification activities.
• Compliance Verification: Ensure strict compliance with ACA CMS NCQA HIPAA state DOI mandates and validate code set updates (ICD-10-CM/PCS CPT HCPCS NDC and revenue code tables).
• Cross-Functional Collaboration: Partner with business analysts claims operations developers and external trading partners to translate requirements into testable scenarios while mentoring junior QA staff.

To be successful in this role you must bring a blend of strong technical QA skills and deep functional knowledge of payer operations.

• Experience: 5 years of software QA/testing experience with at least 3 years specifically supporting health plan claims processing systems.
• Claims Adjudication: Strong experience with medical claims adjudication including COB subrogation remittance processing and claims editing platforms (e.g. ClaimLogic ClaimsXten or similar tools).
• Core Admin Platforms: Hands-on experience working within health plan core administration platforms such as TriZetto FACETS QNXT ika PCM or similar systems.
• Technical Tools: Proficiency with SQL for backend validation alongside experience in Agile/Scrum environments utilizing Jira Azure DevOps Rally or similar project management tools.
• Healthcare Knowledge: Strong understanding of ICD-10 CPT/HCPCS coding structures modifier logic and revenue codes.
• Soft Skills: Excellent analytical troubleshooting documentation and communication skills with the ability to work independently in a fast-paced environment.

• Experience with pharmacy claims testing Medicare Advantage claims processing or PBM integrations.
• Familiarity with test automation and API testing tools including Selenium Postman and SOAP UI.
• Professional QA certifications such as ISTQB or CSTP.
• Bachelors degree in Computer Science Information Systems Healthcare Administration or a related field (equivalent experience will be considered).

• Schedule: Full-time hours must align with Pacific Standard Time (PST) core working hours.
• Location: 100% Remote (US-based)