Pega Tester

Pega Tester

Remote/Norfork VA Need to be onsite when Client Expects

Analyze requirements and design comprehensive manual test cases and test scenarios for claims workflows within the Pega platform

Develop test cases covering end-to-end claims workflows (enrollment, verification, adjudication, denial management, appeals, payment posting); ensure test cases align with business requirements and claims processing rules; document expected results with attention to benefit facet application

Execute manual test cases within Pega environments (development, test, staging) to validate claims processing functionality and business rules

Perform functional testing of Pega case activities, assignments, and workflows; validate claim adjudication accuracy; test benefit facet configurations (deductibles, copays, coinsurance); verify claim calculations and payment logic

Validate Pega business rules engine and claims-specific configurations to ensure accurate claim processing

Test Pega rule configurations (Decision Trees, Decision Tables, Constraints); validate claim decision logic and benefit facet rules; verify coverage determination and claim adjustment rules

Test integration between Pega claims processing and external systems (eligibility/enrollment systems, medical management platforms, provider networks, payment systems)

Validate data flow between Pega and integrated systems; test claim data imports and exports; verify payment posting to external systems; test error handling and data reconciliation

Perform regression testing on Pega system updates, patches, and new releases to ensure existing claims functionality remains intact

Execute regression test suites following Pega version upgrades; identify and report regressions in claims workflows and business rules; support hotfix validation and patch verification

Conduct User Acceptance Testing (UAT) coordination and support, ensuring claims stakeholders can validate business requirements

Prepare UAT test scripts and test data; coordinate with business users and claims teams; guide UAT execution; document defects and change requests; support UAT sign-off

Document and report test results, defects, and issues using test management and defect tracking tools

Create detailed test execution reports; log defects with clear reproduction steps and expected vs. actual results; track defect severity and priority; verify defect fixes through regression testing

Collaborate with business analysts to understand claims workflows, benefit structures, and coverage rules impacting test design

Communicate with claims domain experts to clarify requirements; validate test scenarios against business logic; identify edge cases and boundary conditions specific to claims processing

Validate compliance with healthcare regulations and internal policies in Pega claims workflows

Test claim processing logic for compliance with CMS regulations, state insurance laws, and HIPAA requirements; validate deny reasons and appeals workflows; verify audit trail and claim history logging

Maintain test artifacts and support continuous improvement of testing processes

Organize and maintain test case libraries and test data repositories; update test cases based on requirement changes; contribute to QA process improvements and test automation opportunities.