QA Lead

Role: QA Lead

Key Responsibilities:

• Develop, execute, and maintain end-to-end test scenarios spanning multiple healthcare domains (Member, Enrollment, Claims, Prior Auth, Encounters, Care Management).
  
• Collaborate with Business Analysts, Product Owners, and Stakeholders to understand requirements and translate them into comprehensive test strategies.
  
• Conduct functional, Automation , integration, regression, and UAT support testing across cross-functional modules.
  
• Validate data flow across systems (EDI, downstream platforms, provider/member portals, etc.) and ensure alignment with business rules.
  
• Identify data requirements and create test data (including mock EDI files like 834, 837, 278, etc)
  
• Drive root cause analysis of issues and work independently to resolve or escalate with minimal dependency on development teams.
  
• Ensure compliance with HIPAA and industry standards across testing activities.
  
• Participate in Agile ceremonies, providing test status, risk assessment, and quality insights.
  

Required Skills

• 10+ years with strong expertise across Member Enrollment, Claims, Prior Authorization, Encounters and Care Management domains in the US healthcare ecosystem. The ideal candidate is an independent thinker, able to design and execute test strategies, ensuring comprehensive coverage and quality in complex healthcare systems.
  
• Strong domain expertise in US Healthcare: Member Management, Enrollment (834), Claims (837P/I), Prior Authorization (278), Encounters and Care Management workflows.
  
• Hands-on experience with EDI formats, healthcare platforms, and data validation tools.
  
• Proven ability to work independently, drive testing strategy, and challenge assumptions.
  
• Experience with tools such as JIRA, qtest, ADO, SQL, Postman, and test automation basics (TOSCA, optional but a plus).
  
• Strong communication and analytical skills to work across cross-functional teams.
  
• Ability to troubleshoot data and integration issues across APIs, DBs, and EDI feeds.
  

Key Notes for this Role :

• The Candidates they should have hands-on knowledge in EDI (837 & 834).
  
• Automation, the candidate should be able to do scripting
  

Mandatory Skills :

• The candidate demonstrates good stability, strong communication skills, and an excellent healthcare background with expertise in EDI.