Healthcare Claims Quality Engineer (QE Lead / Senior QA Engineer)

Acumenz Consulting is seeking a Healthcare Claims Quality Engineer to support Agile product delivery teams working in the US healthcare payer domain. The role validates end-to-end claims workflows and performs UI, API, database, and requirements testing, while contributing to automation, CI/CD, and AI-assisted quality engineering. Lead-level candidates also guide test strategy and frameworks, troubleshoot issues, and mentor QA team members.

Responsibilities:

• Validate end-to-end healthcare claims workflows against business and functional requirements
• Perform comprehensive testing across UI, API, database, and business requirements documentation (BRD)
• Design, develop, execute, and maintain test plans, test scenarios, test cases, and automation scripts
• Ensure quality throughout the claims lifecycle, including claim intake, validation, adjudication, pricing, payment, denials, adjustments, and appeals
• Collaborate closely with Product Owners, Business Analysts, Developers, and QA teams within Agile delivery environments
• Manage defects through closure using tools such as JIRA and Zephyr while providing regular status reporting
• Support test data creation and management activities
• Contribute to CI/CD-enabled testing practices and continuous quality improvement initiatives
• Leverage AI-enabled development and testing tools such as GitHub Copilot, Claude, and Cursor AI to improve productivity and testing effectiveness
• For lead-level candidates, provide test strategy guidance, framework design support, troubleshooting expertise, and mentorship to QA team members

Requirements:

• Strong expertise in US Healthcare Payer Operations with hands-on experience supporting Medicare, Medicaid, and Commercial Claims
• Deep understanding of claims adjudication processes and end-to-end claims lifecycle management
• Knowledge of member eligibility, benefits, provider networks, Coordination of Benefits (COB), and reimbursement methodologies
• UI Testing
• API Testing
• Cloud Database Testing
• BRD and Functional Validation
• Strong experience with Playwright automation framework
• Proficiency in at least one programming language: JavaScript, TypeScript, or Python
• Experience working within Agile/Scrum environments
• Familiarity with CI/CD pipelines and modern QA practices
• Experience with JIRA, Zephyr, and defect lifecycle management
• Excellent verbal and written communication skills
• Knowledge of AI concepts and practical experience using AI-assisted testing and development tools
• Experience designing and maintaining automation frameworks using Playwright
• Prior experience leading QA initiatives or mentoring team members
• Exposure to cloud-native testing environments and enterprise healthcare applications
• Strong analytical and problem-solving skills with the ability to work independently and within cross-functional teams