4 - 9 years
5 - 10 Lacs
Posted:1 week ago|
Platform:
Work from Office
Full Time
Job Titile-Manual QA - US Healthcare Claim and EDI
Exp-4+ years
Budget-10 LPA
Location-Gurugram & Bangalore
Role Summary
Responsible for validating US healthcare claims processing and EDI transactions to ensure compliance with HIPAA, CMS, and payer-specific rules. Focus on functional, data, and integration testing across claims lifecycle.
Key Responsibilities
Analyze business requirements for claims, eligibility, benefits, and EDI workflows.
Perform manual functional testing on professional (837P), institutional (837I), and dental (837D) claims.
Validate EDI transactions: 270/271, 276/277, 278, 834, 835.
Test claim adjudication rules: edits, pricing, bundling, COB, capitation, DRG/APC.
Verify remittance advice (835): payments, adjustments, CARC/RARC codes.
Validate member enrollment, provider data (NPI, taxonomy), fee schedules.
Execute end-to-end testing from intake adjudication payment reporting.
Perform data validation using SQL against backend databases.
Log, track, and retest defects; work closely with BA/Dev/PO teams.
Support UAT and regression testing; prepare test cases, scenarios, and RTM.
Required Skills
Strong knowledge of US healthcare domain and claims lifecycle.
Hands-on experience with HIPAA X12 EDI standards.
Understanding of ICD-10, CPT, HCPCS, modifiers, revenue codes.
Knowledge of payer rules (Medicare, Medicaid, Commercial).
SQL for data validation.
Experience with test management tools (JIRA, ALM, Zephyr).
Kezan Consulting
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