Healthcare QA Test Lead Facets Claims & EDI (837/835/834) | Functional Testing Cincinnati - OH - Ohio

Cincinnati OH

Job Description:

>> Strong SME knowledge in Healthcare Claims Processing lifecycle

>> Expertise in EDI formats 837 (PID), 835, 834

>> Hands-on experience in Facets (Claims + Enrollment modules)

>> Proficiency in Azure DevOps (ADO) for QA tracking

>> Knowledge of HIPAA compliance and payer systems

>> 8+ years of experience in Healthcare QATesting

>> 4+ years of experience as Test Lead in Facets projects

>> Deep understanding of Claims Adjudication & Payment workflows

>> Experience in handling claims denials, adjustments, and reprocessing

>> Strong exposure to EDI claim and remittance transactions

>> Experience in mocking and validating EDI files (837835834)

>> Knowledge of ITS claims processing (SF, DF, RF)

>> Experience in Member Enrollment workflows (Medicaid, Medicare, ACA)

>> Understanding of Billing lifecycle for member enrollment

>> Hands-on experience with ADO Test Plans, Test Suites, and Defect tracking

>> Ability to perform data validation and reconciliation activities

>> Strong experience in functional and end-to-end testing Familiarity with AgileScrum methodologies

>> Excellent stakeholder communication and coordination skills

>> Experience in risk identification, defect triage, and RCA

Requirements:

>> Lead end-to-end testing for Claims, Enrollment, and Billing modules

>> Act as SME for Claims Processing and EDI transactions

>> Design and execute test strategies, test plans, and test cases

>> Perform EDI validation (837, 835, 834) including mock data creation

>> Manage defect lifecycle, triage, and resolution tracking in ADO

>> Ensure HIPAA compliance in all testing activities

>> Validate ITS claims processing across SF, DF, RF flows