QA -Facets & Medicaid Regulatory
osition: Senior QA Engineer – Facets & Medicaid Regulatory Solutions Location: Remote Mandatory-Domain expectations across all roles Medicaid Regulatory & Payer Domain & Technology Expertise: Candidates should have strong knowledge of Medicaid managed-care operations and experience working with state-specific Medicaid requirements. They should understand how regulatory changes affect member enrollment/eligibility, coverage, claim processing, authorization, pricing/payment, data and downstream health-plan operations. They should also possess a good working understanding of Medicare and Medicare-Medicaid processes. Candidates must have experience delivering healthcare payer solutions across a combination of TriZetto Facets, Mainframe, Java/J2EE, IBM DataStage, Talend/TalendWorks, databases, batch processing, APIs and system integrations. Candidates should have strong knowledge of Medicaid managed-care processes and state-specific regulatory requirements, together with a good understanding of Medicare and Medicaid health-plan operations, particularly member enrollment, eligibility, benefits, claims adjudication, pricing and payment. Primary Skills Strong Facets + Medicaid + end-to-end cross-platform testing, with ability to validate Mainframe/Java/ETL processing. Role Summary Seeking a Senior QA Engineer with strong Medicaid payer and Facets expertise to independently validate state-specific regulatory implementations across Facets, Mainframe, Java, DataStage, Talend/TalendWorks, and associated applications. Key Responsibilities · Analyze Medicaid regulatory requirements and develop comprehensive test scenarios for individual states. · Validate end-to-end changes across: Facets Mainframe Java applications DataStage Talend/TalendWorks APIs/interfaces Batch systems Upstream/downstream applications · Test regulatory changes involving member enrollment, eligibility, benefits, claims adjudication, pricing, edits, and payments. · Validate Mainframe and Java batch/interface processing. · Perform ETL and source-to-target data validation. · Conduct functional, integration, end-to-end, regression, negative, and boundary testing. · Perform independent quality assessments of regulatory solutions. · Identify gaps between regulatory requirements, requirements documentation, technical implementation, and actual system behavior. · Perform SQL-based data validation and reconciliation. · Conduct defect analysis and support root-cause investigation. · Ensure traceability across Regulation → Business Requirement → System Change → Test Scenario → Test Result. · Required Experience · Strong healthcare payer QA/testing experience. · Strong testing knowledge of TriZetto Facets. · Testing experience across Mainframe and Java-based applications. · Experience validating DataStage and Talend/TalendWorks processes. · SQL and database testing skills. · Strong Medicaid managed-care knowledge. · Experience with state-specific Medicaid requirements. · Good Medicare and Medicaid health-plan knowledge. · Strong understanding of: Member enrollment Eligibility
Benefits
Claims Claims adjudication Pricing Payment · Experience performing quality assessments for complex regulatory implementations.