Test Lead II – Healthcare Payer Testing

🕒 October 16

🇺🇸 United States – Remote

💵 $90k - $120k / year

⏰ Full Time

🟠 Senior

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Develop detailed test cases, scenarios, and scripts for claims processing, enrollment, benefits, provider data, and EDI transaction flows • Lead functional, integration, regression, and UAT cycles for assigned payer modules • Analyze requirements and business rules to identify gaps, ambiguities, and testability issues before execution • Own defect lifecycle management, including logging, triage, root cause classification, retesting, and closure tracking • Validate EDI transactions (834, 837, 835, 270/271, 820) against payer business rules and X12 standards • Support compliance and regulatory test cycles, including ICD updates, CMS mandates, and state-specific Medicaid rules • Coordinate with developers, business analysts, and configuration teams to resolve blockers and clarify expected behavior • Produce daily and weekly execution status reports with defect metrics, coverage status, and risk flags • Manage offshore QA analysts • Collaborate closely with the Test Manager and cross-functional delivery teams

🎯 Requirements

• 5+ years in software QA/testing • 2+ years in a lead or senior tester role • Solid experience testing U.S. healthcare payer systems, including claims, enrollment, benefits, or provider network • Working knowledge of EDI X12 transactions and HIPAA compliance requirements • Hands-on test case design experience using boundary analysis, equivalence partitioning, and negative testing techniques • Proficiency in defect tracking and test management tools such as JIRA, Zephyr, ALM, or equivalent • Ability to read and interpret payer business rules, EOPs, benefit plan documents, and SLAs • Strong attention to detail • Candidates may be required to undergo a pre-employment criminal background check

🏖️ Benefits

• Remote work arrangement • Working hours aligned to Eastern Standard Time • Up to 5% travel • Reasonable accommodations for individuals with disabilities • Equal opportunity employment • Workforce diversity and inclusion

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