Manager, IT Testing (Claims domain)

Conduent State Healthcare, LLC•, Remote US

6d•$97,790 - $127,000

About The Position

Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments. This role is for a Claims Domain Test Manager for MMIS health care projects. The manager will drive the test strategy and process, utilize domain knowledge, analyze business requirements, design and develop test plans, ensure quality processes, and coordinate with customers on delivery and deployments. The role involves working in a team environment, providing testing guidance throughout the entire life cycle, meeting customer expectations, troubleshooting application problems, and assisting customers in implementation decisions.

Requirements

Strong health care domain experience.
Good knowledge of Medicaid and Medicare.
Hands-on experience on claims processing and Adjudication processes.
Good experience in Reference code/data sets required in Claims adjudication.
Prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
Excellent written and spoken communication skills.
Ability to multitask between internal team and clients based on priority tasks.
In-depth understanding of Claims and Claims lifecycle (Member, Provider, Claim submission – Paper and EDI X12, Adjudication, Payment Cycle (Finance), Reporting).
Knowledge of Claim Types: Professional, Dental, Institutional, Pharmacy, Encounters and Capitation.
Knowledge of Claim Formats: EDI X12 formats like 837P/I/D, X12 formats 835, 834, 270/271, 276/277.
Familiarity with systems like CMdS, GHS, Facets.
Familiarity with test management tools like ADO, JIRA.
Familiarity with Interface/API testing tools like Postman.
Minimum of 10+ years of experience in health care experience especially in MMIS domain.
SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).
EDI Tools: Validating X12 files.
Interface Testing: Understanding how data flows between systems and formats and use tools like postman.
Capability to think out-of-the-box to create new solutions as needed.
Ability to validate Test scenarios and test plans, test data.
Excellent communication (written and spoken) skills to engage with different stake holders like QA/dev team, clients, end users of Clients and Business Units.

Nice To Haves

Ability to assess current functionality available in a product vis a vis market trends, regulatory requirements to be implemented in future version of the product.
Ability to drive and share the requirements with Technical and Architects regarding product features to be implemented.

Responsibilities

Play the role of Claims Domain test manager for MMIS health care projects.
Drive the test strategy and process.
Perform analysis of business requirements.
Design and develop test plans.
Ensure quality process.
Coordinate with customers on delivery and deployments.
Provide testing guidance throughout the entire life cycle.
Meet customer expectations.
Troubleshoot problems in the application.
Assist customers in implementation decisions.
Work closely with the client and development team during the stages of development.
Conduct demos at completion of milestones.
Track and close feedback from demos.
Work closely with Dev, architecture and Design teams to define the GUI view and platform requirements.
Validate the entire flow from claim intake to payment and reporting.
Test integration points between systems (Interface testing).
Design test cases based on business rules, coverage policies, and system configurations.
Run queries and perform basic system analysis, RCA etc.
Review requirements, documentation and create Requirements Traceability Matrix (RTM).
Assess current functionality available in a product vis a vis market trends, regulatory requirements to be implemented in future version of the product.
Drive and share the requirements with Technical and Architects regarding product features to be implemented.
Create test plans, test summary reports, and traceability matrices.
Collaborate with cross-functional teams including developers, SME’s and BA’s.