[Remote] QA -Facets & Medicaid Regulatory

Note: The job is a remote job and is open to candidates in USA. KTek Resourcing is recruiting for a Senior QA Engineer role focused on Medicaid payer and Facets expertise. The role independently validates state-specific regulatory implementations across Facets, Mainframe, Java, ETL processes, and associated applications.

Responsibilities

• Analyze Medicaid regulatory requirements and develop comprehensive test scenarios for individual states
• Validate end-to-end changes across: 1. Facets 2. Mainframe 3. Java applications 4. DataStage 5. Talend/TalendWorks 6. APIs/interfaces 7. Batch systems 8. 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

Skills

• 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
• Strong Facets + Medicaid + end-to-end cross-platform testing, with ability to validate Mainframe/Java/ETL processing
• 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: 1. Member enrollment 2. Eligibility 3. Benefits 4. Claims 5. Claims adjudication 6. Pricing 7. Payment
• Experience performing quality assessments for complex regulatory implementations

Benefits

• Remote work

Company Overview

Company H1B Sponsorship