Strong Manual tester with Healthcare Payer Industry Knowledge, EDI Transactions and Core Claims processing. Automation testing is a good to have but not mandatory.
Healthcare domain knowledge and expertise in Payer (Commercial, Medicare/Medicaid, State Health Plan) and Third Party Administrator business areas.
Experience in QE & Testing aspects relating to key areas like Claims Processing (Claims Intake, Preprocessing, Adjudication, Payments/Remittance, Recovery) and Membership Enrollment (Enrollment Intake , Preprocessing, Fulfillment).
Hands on experience in Testing EDI HIPAA 5010 Transactions including 837,834, 835, 270, 271, 276, 277. Thorough with the Transaction semantics, structure and content at the Segment, loop and attribute level and must be familiar with EDI Gateways and SNIP validations.
Must be able to create/build EDI test files like 837 and must be able to validate the related data (Claims data) in the Core system post processing.
Must possess skills in writing ANSI SQL queries to extract data in the context of data analysis and validation. Knowledge of RDBMS like Sybase/SQL Server/ Oracle will be important.
Must have participated in Test Planning and Tracking aspects, SQA processes and methodology.