Test Lead – Healthcare Payer Testing

Job not on LinkedIn

🔥 18 minutes ago

🇺🇸 United States – Remote

💵 $100k - $120k / year

⏰ Full Time

🟠 Senior

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

⚕️ Healthcare Insurance

☁️ SaaS

💳 Fintech

Healthcare Insurance • SaaS • Fintech

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 — identify gaps, ambiguities, and testability issues before execution begins • Own defect lifecycle management: logging, triage, root cause classification, retest, 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 — ICD updates, CMS mandates, state-specific Medicaid rules • Coordinate with developers, BAs, and configuration teams to resolve blockers and clarify expected behavior • Produce daily/weekly execution status reports with defect metrics, coverage status, and risk flags • Manages offshore QA analysts.

🎯 Requirements

• 5+ years in software QA/testing • 2+ years in a lead or senior tester role • Solid experience testing U.S. healthcare payer systems — 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 (JIRA, Zephyr, ALM, or equivalent) • Ability to read and interpret payer business rules, EOPs, benefit plan documents, and SLAs • Strong attention to detail — payer system defects have financial and compliance consequences.

🏖️ Benefits

• HealthEdge is an equal opportunity employer • Committed to workforce diversity