QA Engineer
JD #1: SDET Engineer - Encounter Data Processing
Job Description:
Healthcare Domain - Encounter data processing X12 837 submissions to Medicaid/Medicare Advantage/TRICARE/Marketplace, acknowledgements, reconciliation, CMS & state companion guides
Core Skills Needed - Facets (REQUIRED), X12 EDI (837P/I/D, 277CA, 999/TA1), SQL, EDI validation tooling (Edifecs), TOSCA/Robot Framework
Core technical & domain requirements:
Facets REQUIRED: claims module familiarity (encounters are derived from Facets claims data); Facets-to-encounter data validation
X12 EDI knowledge: 837P, 837I, 837D (Professional, Institutional, Dental) transaction structure, loops, segments
277CA (Claim Acknowledgement) and 999/TA1 validation
Encounter submission & acceptance rules Medicaid, Medicare Advantage, TRICARE, Marketplace
Edifecs or equivalent EDI validation tooling
SQL for encounter data validation (claim header, detail, member eligibility cross-checks)
TOSCA or Robot Framework test automation
Healthcare payer domain: CMS encounter submission rules, state-specific companion guide
Responsibilities:
Independently design encounter lifecycle scenarios across 837/277CA/999/TA1.
Build and maintain TOSCA/Robot Framework automation for encounter regression.
Lead reconciliation between source claims and submitted encounters.
Own encounter test design and submission-edit validation across LOBs.
Drive automation coverage and mentor analysts on EDI validation.
Conduct RCA on rejections and state/CMS edit failures.
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JD #2: SDET Engineer - CRM / IVR / ESB / InterOps
Job Description:
Healthcare Domain - Member/provider experience & integration CRM, IVR, ESB/middleware, and healthcare interoperability (FHIR R4, HL7, CMS Patient Access & Provider Directory APIs)
Core Skills Needed - Facets (REQUIRED, integration-level), API testing (REST/SOAP), ESB/middleware validation, CRM/IVR testing, FHIR R4/HL7, SQL, ADO
Core technical & domain requirements:
Facets REQUIRED: integration-level knowledge (eligibility, benefits, claims data surfaced from Facets via APIs/ESB); ability to validate Facets-sourced data through this layer
Integration & middleware testing spanning CRM, IVR, ESB, and interoperability layers breadth over depth
Hands-on API testing REST/SOAP using Postman, SoapUI, or RestAssured
ESB/middleware message-flow validation routing, transformation, payload accuracy, error handling
CRM or contact-center platform testing workflows, case management, call routing, IVR navigation
Working knowledge of FHIR R4 APIs or HL7 messaging - willingness to ramp on interoperability standards
SQL for cross-system data validation across integrated platforms
Healthcare domain familiarity preferred; strong integration-testing background with ramp-up ability acceptable.
Responsibilities:
Own API/integration test design across CRM, ESB, and InterOps.
Validate FHIR R4/HL7 exchanges and CMS interoperability API conformance.
Lead defect triage across integrated services.
Own integration/interoperability test design and standards.
Drive automation coverage; mentor the 10-member squad's engineers.
Lead complex end-to-end validation across CRM, IVR, ESB, and partners.
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JD #3: SDET Engineer - Member enrollment & eligibility
Job Description:
Healthcare Domain - Member enrollment & eligibility - X12 834 maintenance, retro adjustments, deeming, 820 premium linkage, reconciliation across Medicaid/MA/Duals/MMP/TRICARE/Marketplace
Core Skills Needed - Facets (REQUIRED), X12 EDI (834, 820, 270/271), SQL, TOSCA, ADO, enrollment reconciliation
Core technical & domain requirements:
Facets - REQUIRED: membership/enrollment module testing, subscriber/member configuration, and 834-to-Facets data flow validation
X12 EDI: 834 (Benefit Enrollment & Maintenance) - full transaction expertise
Member add/change/term, dependent handling, dual-enrollment scenarios
Retroactive adjustments and deeming logic (Medicaid/MMP/Dual)
820 (Premium Payment) validation linkage
Member eligibility cross-validation (270/271 correlation)
Enrollment reconciliation: source system vs. downstream (enrollment DB ↔ claims ↔ eligibility)
SQL for member-level data comparisons (effective dates, plan codes, LOB flags)
TOSCA or similar automation tool
LOB knowledge: Medicaid, Medicare Advantage, Duals/MMP, TRICARE, Marketplace
Responsibilities:
Design enrollment scenarios including retro, term, and dual-enrollment.
Build/maintain automation; lead 820 linkage and 270/271 correlation testing.
Lead reconciliation between 834 source and downstream member records.
Own offshore enrollment test design across LOBs and deeming logic.
Drive automation coverage and mentor analysts.
Conduct RCA on eligibility and reconciliation discrepancies.
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JD #4: SDET Engineer - Provider data management
Job Description:
Healthcare Domain - Provider data management - directory accuracy, credentialing, prior authorization (278), eligibility (270/271), 835 payment linkage across Medicaid/MA/Duals/TRICARE/Marketplace
Core Skills Needed - Facets (REQUIRED), X12 EDI (278, 270/271, 835), provider data (NPI/TIN/taxonomy), SQL, TOSCA, ADO
Core technical & domain requirements:
Facets
Facets - REQUIRED: provider, contract, and network module testing and configuration validation in Facets
X12 EDI: 278 (Prior Authorization request & response), 270/271 (Eligibility & Benefit inquiry/response)
Provider demographic data validation - NPI, TIN, taxonomy codes, specialty, address, network status
Provider enrollment & credentialing workflow testing (add, update, term, reactivation)
835 remittance linkage to provider payment validation
Provider directory accuracy testing - plan-level, network-tier, accepting-new-patients flags
SQL for provider data cross-validation (provider master ↔ claims ↔ eligibility ↔ directory)
TOSCA or similar automation tools
LOB coverage: Medicaid, Medicare Advantage, Duals/MMP, TRICARE, Marketplace
Responsibilities:
Design provider data, directory-accuracy, and credentialing-workflow scenarios.
Build/maintain automation; test 278 and 270/271 transactions.
Validate 835 payment linkage and lead feature-level triage
Own offshore provider test design across LOBs.
Drive automation coverage and mentor analysts.
Conduct RCA on directory/network and authorization discrepancies.