Quality Assurance Analyst - Healthcare Claims
Job Title Quality Assurance Analyst – Healthcare Claims Location Remote (USA) Employment Type Full-Time Job Summary We are seeking a detail-oriented Quality Assurance Analyst with strong experience in Healthcare Claims processing and testing. The ideal candidate will be responsible for validating healthcare claims workflows, ensuring data accuracy, identifying defects, and maintaining the highest quality standards across healthcare applications. This role requires expertise in healthcare claims adjudication, benefits, eligibility, provider data, and end-to-end testing methodologies.
Key Responsibilities
Develop, execute, and maintain test plans, test cases, and test scripts for healthcare claims applications. Validate healthcare claims processing, including claim adjudication, payment integrity, eligibility, and benefits verification. Perform functional, integration, regression, system, and UAT testing. Analyze business requirements and translate them into comprehensive test scenarios. Identify, document, track, and manage defects through resolution. Validate EDI transactions including 837 Claims, 835 Remittance, and 270/271 Eligibility transactions. Collaborate with Business Analysts, Developers, Product Owners, and Operations teams to ensure quality deliverables. Execute SQL queries to validate backend data and claims processing results. Support production validation, root cause analysis, and issue resolution. Ensure compliance with healthcare regulations and business rules. Participate in Agile ceremonies including sprint planning, grooming, and retrospectives.
Required Qualifications
Bachelor's degree in computer science, Information Technology, Healthcare Administration, or related field. 6+ years of Quality Assurance experience. 3+ years of hands-on experience in Healthcare Claims testing. Strong understanding of: Claims Adjudication Provider and Member Data Benefits & Eligibility Enrollment Healthcare Claims Lifecycle Experience with manual and/or automated testing methodologies. Strong knowledge of SQL and database validation. Experience with defect tracking tools such as Jira, Azure DevOps, or ALM. Understanding of Agile/Scrum methodologies.
Preferred Qualifications
Experience with PBM, Medicare, Medicaid, or Commercial Health Plans. Knowledge of HIPAA and healthcare compliance standards. Experience with API testing using Postman, SOAP UI, or similar tools. Exposure to test automation tools such as Selenium, Cypress, or Playwright.