Quality Assurance Engineer

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

👻 Ghost score 10%

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Health Network One

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1999

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Health Network One is a healthcare network management company that partners with health plans to manage specialty outpatient services (including outpatient therapy, routine and medical eye care, dermatology, and podiatry) under full-risk arrangements. The company operates nationally, covering over 7 million lives and contracting with tens of thousands of providers, and offers delegated services such as utilization management, credentialing, claims and network management. Health Network One emphasizes value‑based solutions, clinical quality, cost reduction for professional and facility spend, and holds NCQA accreditation and HITRUST CSF certification.

📋 Description

• Partner with IT, Operations, Configuration, EDI, Reporting, Business Analysts, and other cross-functional stakeholders to ensure system changes are thoroughly tested before deployment • Design, build, and maintain non-production testing environments that replicate end-to-end managed care workflows and system interactions • Develop and maintain test data libraries covering provider, member, eligibility, authorization, referral, claims, pricing, payment, reporting, and data exchange workflows • Establish processes for refreshing, validating, and governing test data while maintaining regulatory and privacy compliance • Coordinate environment readiness and testing schedules across projects and releases • Monitor testing environments for availability, stability, and data integrity • Develop test strategies, test plans, test scripts, and test cases for enhancements, APIs, interfaces, integrations, regulatory workflows, and production fixes • Execute functional, regression, integration, user acceptance, and end-to-end testing • Validate system logic, master data, configuration, benefit rules, provider data, authorization and referral workflows, claims adjudication, payment processes, reporting outputs, and downstream integrations • Verify system behavior against business requirements and operational specifications • Apply risk-based testing based on business impact, operational risk, and regulatory requirements • Validate functionality related to HIPAA, CMS requirements, interoperability mandates, delegated services, and other applicable regulations • Identify, document, prioritize, and track defects through resolution • Investigate root causes and validate fixes with developers, analysts, and operational stakeholders • Retest defects and verify remediation before production deployment • Liaise between IT and operational teams during testing activities • Translate business requirements and operational workflows into testing scenarios • Recommend improvements to QA methodologies, testing tools, automation opportunities, and release management processes • Design, develop, and maintain automated test scripts • Support production issue investigations and post-implementation validation • Provide testing status updates, risk assessments, and defect summaries to project teams and leadership • Maintain testing standards, procedures, and documentation repositories • Develop QA metrics and dashboards measuring testing effectiveness and release quality

🎯 Requirements

• Bachelor's degree in Information Technology, Computer Science, Information Systems, Healthcare Administration, Business, or a related field, or equivalent work experience • 3+ years of software quality assurance or software testing experience • Experience supporting healthcare technology platforms, managed care operations, payer systems, provider network systems, claims processing platforms, or related enterprise applications • Experience creating test plans, test scripts, and executing structured testing methodologies • Experience working in Agile, Waterfall, or hybrid project environments • Experience with healthcare interoperability standards including FHIR, HL7, X12, and API-based integrations • Experience validating CMS interoperability and prior authorization workflows • Strong understanding of software development lifecycle (SDLC) and quality assurance practices • Strong analytical and problem-solving skills • Excellent attention to detail and documentation capabilities • Ability to manage multiple priorities and deadlines simultaneously • Strong verbal and written communication skills • Ability to collaborate effectively with technical and non-technical stakeholders • Proficiency with Microsoft Office Suite, particularly Excel • Technical familiarity with APIs, interfaces, and system integrations • Working knowledge of SQL for data validation, troubleshooting, and root cause analysis • Experience using defect tracking and test management tools • Preferred: experience with managed care, payer administration, provider network, care management, authorization, claims, or related healthcare enterprise platforms • Preferred: experience with SQL and database validation • Preferred: experience with test automation tools • Preferred: experience with AI-enabled testing tools • Preferred: knowledge of EDI transactions, including 837 and 835 files • Preferred: healthcare payer, TPA, managed care, delegated services, provider network, utilization management, or specialty benefit management experience • Preferred: QA certifications such as ISTQB, CSTE, or equivalent

🏖️ Benefits

• Remote work arrangement • Flexible candidate location within the U.S.