Manager, IT Testing (Claims domain)

Conduent•Gates, NY

13d•$97,790 - $127,000

About The Position

Play the role of Claims Domain test manager for MMIS health care projects. Drive the test strategy and process, domain knowledge, perform analysis of business requirements, design and develop test plans, ensure quality process, coordinates with customers on delivery and deployments. Works in team environment and provides testing guidance throughout the entire life cycle. Responsible to meet customer expectations, troubleshoot problems in the application and assisting customers in implementation decisions.

Requirements

Minimum of 10+ years of experience in health care experience especially in MMIS domain.
Strong health care domain experience and should have 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.
Ability to run queries and perform basic system analysis, RCA etc.
Excellent written and spoken communication skills.
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 Claim Systems like CMdS, GHS, Facets and etc.
Validate the entire flow from claim intake to payment and reporting.
Test integration points between systems.
Design test case based on business rules, coverage policies, and system configurations.
Familiarity with test management tools like ADO, JIRA.
Familiarity with Interface/API testing tools like Postman.
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.
Ability to review requirements, documentation and create Requirements Traceability matrix (RTM).
Excellent communication (written and spoken) skills to engage with different stake holders like QA/dev team, clients, end users of Clients and Business Units.
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.
Create test plans, test summary reports, and traceability matrices.
Collaborate with cross-functional teams including developers, SME’s and BA’s.

Responsibilities

Strong health care domain experience with 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.
Ability to run queries and perform basic system analysis, RCA etc.
Work closely with the client and development team during the stages of development, and conduct demos at completion of milestones, track and close feedback from such demos.
Excellent written and spoken communication skills. Ability to multitask between internal team and clients based on priority tasks.
Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.
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 Claim Systems like CMdS, GHS, Facets and etc.
Testing knowledge and E2E Testing: Validate the entire flow from claim intake to payment and reporting.
Interface testing - Test integration points between systems.
Design test case based on business rules, coverage policies, and system configurations.
Familiarity with test management tools like ADO, JIRA.
Familiarity with Interface/API testing tools like Postman.
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.
Ability to review requirements, documentation and create Requirements Traceability matrix (RTM).
Excellent communication (written and spoken) skills to engage with different stake holders like QA/dev team, clients, end users of Clients and Business Units.
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.
Test Planning & Reporting: Create test plans, test summary reports, and traceability matrices.
Communication: Collaborate with cross-functional teams including developers, SME’s and BA’s.