Job
Description
Key Responsibilities: Pharmacy Benefits Domain Knowledge: Leverage knowledge of US Pharmacy standards, regulations, and practices (e.g., HIPAA, ICD-10, CPT codes, etc.) to ensure the system complies with industry-specific requirements and test as per the US Pharmacy Standards. Claims Testing: Testing pharmacy claims processes (adjudication, pricing, benefit configuration) while ensuring compliance with HIPAA, EDI (837/835/276/277), and ANSI X12 standards. It includes end-to-end claims lifecycle testing and validating ICD, CPT, and HCPCS codes. Verifying integrations with clearinghouses and payers. Test Planning and Execution: Develop detailed test plans, scenarios, and scripts to ensure comprehensive test coverage of business processes. Execute test cases manually or with automation tools. End-to-End Testing: Plan, design, and execute end-to-end test cases to verify the functionality and workflow of the system. Ensure complete traceability and coverage from requirement gathering to deployment. Defect Management: Identify, document, and track defects using defect management tools. Collaborate with development teams to resolve issues and ensure timely delivery of high-quality software. Collaboration with Cross-Functional Teams: Work closely with business analysts, developers, product managers, and other stakeholders to ensure that requirements are met and quality is maintained throughout the software development lifecycle. Automation: Able to work with test automation frameworks (e.g., Selenium, Gherkin, etc.) to create and execute automation test scripts. Required Qualifications: Experience: Minimum of 5 years of experience in Quality Engineering or Software Testing, particularly in the US Pharmacy Benefits domain, with a focus on Pharmacy Claims management. Pharmacy Healthcare Domain Expertise: Strong knowledge of US Pharmacy Healthcare industry standards, including pharmacy claims lifecycle, coding systems (ICD-10, CPT, HCPCS), and compliance (HIPAA, etc.). End-to-End Testing Experience: Proficiency in performing end-to-end testing, including functional, integration, and regression testing, from requirements through deployment. Testing Tools: Experience with test management tools and defect tracking systems. Automation Experience: Familiarity with test automation frameworks (e.g., Selenium, Gherkin, etc.) is a plus. Problem-Solving Skills: Ability to analyze complex business requirements and provide clear, actionable insights during the testing process. Attention to Detail: High attention to detail, ensuring accuracy and completeness of testing activities. Communication Skills: Strong written and verbal communication skills to effectively document test results, communicate defects, and collaborate with stakeholders. Agile Methodology: Experience working in Agile environments and participating in sprint planning, daily stand-ups, and sprint retrospectives.
