Senior Healthcare Payer Claims QA Engineer

Cognizant is hiring a Senior Healthcare Payer Claims QA Engineer to ensure the quality, accuracy, and reliability of healthcare payer claims-processing applications and integrations. The role validates claims workflows, EDI/X12 transactions, backend data, and downstream outcomes in collaboration with business, development, and quality engineering teams.

Responsibilities:

• Analyze healthcare claims requirements, user stories, and business rules to develop comprehensive test scenarios and test cases
• Execute functional, regression, integration, and end-to-end testing across healthcare payer claims-processing workflows
• Validate the claims lifecycle, including pre-adjudication logic, business validations, claim edits, rejects, pend scenarios, and downstream claim outcomes
• Perform EDI/X12 transaction testing with a strong focus on 837 Professional (837P) and 837 Institutional (837I) transactions and related healthcare claims interfaces
• Perform SQL and database validation, data analysis, reconciliation, and test-data preparation to support test execution
• Conduct API and integration testing to validate accurate data exchange between upstream and downstream applications
• Investigate defects, perform root-cause analysis, collaborate with development teams, and drive issues through resolution and closure
• Develop, maintain, and execute automated test scripts using Selenium, Playwright, or similar automation frameworks, while leveraging AI-assisted testing techniques where applicable

Requirements:

• Bachelor's degree in computer science, Information Technology, Engineering, or a related field
• 8+ years of software testing experience within Healthcare Payer claims-processing environments
• Strong hands-on experience testing Healthcare Payer claims applications and workflows
• Strong understanding of the end-to-end claims' lifecycle, including pre-adjudication, business validations, claim edits, rejects, pend processing, and downstream claim outcomes
• Hands-on experience testing EDI/X12 healthcare claims transactions, particularly 837P and 837I
• Strong SQL and database-testing skills, including backend data validation, reconciliation, and test-data preparation
• Experience creating and executing functional, regression, integration, and end-to-end testing for complex claims-processing workflows
• Knowledge of PEGA-based healthcare solutions
• Experience with API and integration testing using modern testing tools and methodologies
• Hands-on automation experience using Selenium, Playwright, or similar test-automation frameworks
• Experience using AI-powered testing tools or GenAI capabilities for test-case generation, test optimization, automation acceleration, defect prediction, or other quality-engineering activities