Claims Adjudication System Tester

TEKsystems • Elkridge, MD

3d • Hybrid

About The Position

We are seeking a Claims Adjudication System Tester/Validator to join our Testing Department. This position is responsible for developing and validating test plans, conducting acceptance and regression testing for the heath claims processing system and other interactive systems. PRIMARY ACCOUNTABILITIES: • Primarily focusing on testing and validation for upgrades, add-ons, benefit changes and continued maintenance of the QNXT claims processing system. • Testing and validation of all business-related applications. • Work with Health Plan Business Analysts (and others as needed) to ensure that test plans and scenarios cover all testable requirements and provides detailed feedback to the Information Technology staff related to application set-up or possible design flaws. • Keep detailed testing documentation including screen prints of system set-up and testing results, both positive and negative. • Review and/or develops reports as needed to ensure thorough testing as well as to identify trends in system issues; • Identify innovative methodologies to guarantee that tests are as fail-safe as possible and that potential fallout from fixes is tested; • Documents details of bugs found during testing and notifies affected parties; • Schedules status meetings as necessary to include all affected parties; • Maintain and/or enhance system skills as needed to sustain a superior knowledge of the Plan’s workflow, policies, procedures and system(s) capabilities. • Work hours outside of normal work day/week when necessary; • Other duties as assigned.

Requirements

• 2-4 years software testing experience or 5+ years of experience in testing methodology and practical application in a healthcare environment.
• A minimum of 3 years healthcare claims processing, review or support staff experience.
• Excellent verbal and written communication skills.
• Excellent problem solving and issue identification skills.
• Ability to work well independently.
• Proficiency with Microsoft Suite.

Nice To Haves

• SQL knowledge preferred.
• Experience with the QNXT system is preferred.
• Experience and proficiency with claims editing software.
• Experience and proficiency with Claim Test Pro a plus.
• Experience with automated test tools a plus.
• A.A. degree and professional industry certification preferred.

Responsibilities

• Primarily focusing on testing and validation for upgrades, add-ons, benefit changes and continued maintenance of the QNXT claims processing system.
• Testing and validation of all business-related applications.
• Work with Health Plan Business Analysts (and others as needed) to ensure that test plans and scenarios cover all testable requirements and provides detailed feedback to the Information Technology staff related to application set-up or possible design flaws.
• Keep detailed testing documentation including screen prints of system set-up and testing results, both positive and negative.
• Review and/or develops reports as needed to ensure thorough testing as well as to identify trends in system issues.
• Identify innovative methodologies to guarantee that tests are as fail-safe as possible and that potential fallout from fixes is tested.
• Documents details of bugs found during testing and notifies affected parties.
• Schedules status meetings as necessary to include all affected parties.
• Maintain and/or enhance system skills as needed to sustain a superior knowledge of the Plan’s workflow, policies, procedures and system(s) capabilities.
• Work hours outside of normal work day/week when necessary.
• Other duties as assigned.

Benefits

• Prescription Drug Coverage: The plan covers most adult Part D vaccines at no cost and insulin products at a maximum of $35 per month.
• MedicareRx Part D Prescription Drug Plan (PDP): The plan applies separate deductibles and out-of-pocket maximums for each enrolled individual. Members may be eligible for reimbursement of out-of-pocket costs through their Personal Care Account (PCA).
• Consumer Driven Option: This option allows members to be reimbursed for MedicareRx Part D costs, with the amount varying based on enrollment status and rewards earned.
• Minimum Essential Coverage: The plan qualifies as minimum essential coverage and meets the minimum value standard for the benefits provided.
• Creditable Coverage: The plan's prescription drug coverage is considered creditable coverage, meaning members do not need to enroll in an open market Medicare Part D plan and pay extra for prescription drug coverage.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree