Healthcare QA Test Lead Facets Claims & EDI Functional Testing Cincinnati - OH - Ohio

Cincinnati OH

Job Description:

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Strong SME knowledge in Healthcare Claims Processing lifecycle

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

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

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Proficiency in Azure Dev Ops (ADO) for QA tracking

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Knowledge of HIPAA compliance and payer systems

>> 8+ years of experience in Healthcare QATesting

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

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Deep understanding of Claims Adjudication & Payment workflows

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Experience in handling claims denials, adjustments, and reprocessing

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Strong exposure to EDI claim and remittance transactions

>> Experience in mocking and validating EDI files )

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

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

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Understanding of Billing lifecycle for member enrollment

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

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Ability to perform data validation and reconciliation activities

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Strong experience in functional and end-to-end testing Familiarity with Agile Scrum methodologies

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Excellent stakeholder communication and coordination skills

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Experience in risk identification, defect triage, and RCA

Requirements:

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

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Act as SME for Claims Processing and EDI transactions

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

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

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Manage defect lifecycle, triage, and resolution tracking in ADO

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Ensure HIPAA compliance in all testing activities

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Validate ITS claims processing across SF, DF, RF flows