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 - 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.