Lead Quality Assurance Engineer

Covetus is seeking a Lead Quality Assurance Engineer to support healthcare payer quality engineering. The role focuses on testing claims and encounters, payer platforms, X12 EDI transactions, APIs, databases, and enterprise applications, while leading QA activities across Agile delivery, UAT, and go-live processes.

Responsibilities:

• Strong experience with healthcare payer processes and Lines of Business such as Medicaid, Medicare Advantage, Duals/MMP, TRICARE, or Marketplace
• Strong hands-on experience testing Healthcare Claims or Encounters, including 837 transactions, adjudication/validation, reconciliation, and downstream payer workflows
• Experience with Facets modules such as Claims, Membership/Enrollment, or Provider/Network configuration is highly desirable
• Strong understanding of X12 EDI transactions, including 834, 837P/I/D, 277CA, 999/TA1, 835, 278, 270/271, and 820
• Ability to independently read and understand EDI loops, segments, and companion guides
• Knowledge of CMS/state Medicaid encounter submissions, HIPAA, FHIR R4/HL7, interoperability, provider directories, and audit traceability
• Understanding of payer operations including provider data, enrollment reconciliation, prior authorization, premium billing, capitation, claims-to-GL reconciliation, and MLR reporting
• Strong test design skills with the ability to derive test scenarios from business rules, requirements, and EDI companion guides
• Experience designing source-to-system-to-downstream data reconciliation and performing root-cause analysis and defect triage
• Strong hands-on SQL skills, including complex multi-table queries for cross-system data validation
• Experience with API and integration testing using REST/SOAP and tools such as Postman, RestAssured, or SoapUI
• Experience with Selenium or Playwright for UI automation, including authentication, SSO/MFA, role-based access, and cross-browser testing
• Hands-on experience with TOSCA and/or Robot Framework
• Experience with Azure DevOps for test management, defect tracking, and CI/CD
• Strong Python or Java skills for test automation, utilities, data validation, and parsing
• Experience with AI-assisted testing, including LLM-based test generation, synthetic test data, and defect analysis using tools such as Copilot, Azure OpenAI, or Claude
• Experience working in Agile/Scrum environments with ownership of sprint-level QA activities
• Strong defect management, root-cause analysis, regression, SIT, UAT, and go-live experience
• Ability to collaborate directly with business stakeholders, developers, product owners, and client teams
• Strong communication skills and the ability to independently lead QA discussions during UAT and business reviews
• Offshore candidates should be comfortable maintaining approximately 4 hours of daily overlap with US Eastern Time

Requirements:

• Strong experience with healthcare payer processes and Lines of Business such as Medicaid, Medicare Advantage, Duals/MMP, TRICARE, or Marketplace
• Strong hands-on experience testing Healthcare Claims or Encounters , including 837 transactions, adjudication/validation, reconciliation, and downstream payer workflows
• Strong understanding of X12 EDI transactions , including 834, 837P/I/D, 277CA, 999/TA1, 835, 278, 270/271, and 820
• Ability to independently read and understand EDI loops, segments, and companion guides
• Knowledge of CMS/state Medicaid encounter submissions, HIPAA, FHIR R4/HL7, interoperability, provider directories, and audit traceability
• Understanding of payer operations including provider data, enrollment reconciliation, prior authorization, premium billing, capitation, claims-to-GL reconciliation, and MLR reporting
• Strong test design skills with the ability to derive test scenarios from business rules, requirements, and EDI companion guides
• Experience designing source-to-system-to-downstream data reconciliation and performing root-cause analysis and defect triage
• Strong hands-on SQL skills, including complex multi-table queries for cross-system data validation
• Experience with API and integration testing using REST/SOAP and tools such as Postman, RestAssured, or SoapUI
• Experience with Selenium or Playwright for UI automation, including authentication, SSO/MFA, role-based access, and cross-browser testing
• Hands-on experience with TOSCA and/or Robot Framework
• Experience with Azure DevOps for test management, defect tracking, and CI/CD
• Strong Python or Java skills for test automation, utilities, data validation, and parsing
• Experience with AI-assisted testing , including LLM-based test generation, synthetic test data, and defect analysis using tools such as Copilot, Azure OpenAI, or Claude
• Experience working in Agile/Scrum environments with ownership of sprint-level QA activities
• Strong defect management, root-cause analysis, regression, SIT, UAT, and go-live experience
• Ability to collaborate directly with business stakeholders, developers, product owners, and client teams
• Strong communication skills and the ability to independently lead QA discussions during UAT and business reviews
• Medicaid experience is highly preferred
• Experience with Facets modules such as Claims, Membership/Enrollment, or Provider/Network configuration is highly desirable
• Edifecs or similar EDI validation tools are a plus
• Distributed execution experience with TOSCA is a plus
• qTest experience is a plus
• Candidates with strong Healthcare Payer QA experience and deep expertise in either Claims or Encounter testing are encouraged to apply
• Experience with Medicaid, Facets, X12 EDI, SQL, API testing, and enterprise test automation will be highly valued