Senior Test / QA Analyst

HJ Staffing • Huntington Beach, CA

5d • Remote

About The Position

We are seeking an experienced Senior Test / QA Analyst to support a prominent West Coast healthcare client focused on health plan claims processing systems. This require a high-level QA professional who can hit the ground running in a fast-paced payer environment. In this role, you will leverage your deep expertise in healthcare claims adjudication, EDI transaction testing, regulatory compliance, and enterprise quality assurance methodologies. The ideal candidate is highly analytical, detail-oriented, and has a proven track record of leading testing efforts across complex payer environments involving medical, pharmacy, and dental/vision claims.

Requirements

• 5+ years of software QA/testing experience, with at least 3 years specifically supporting health plan claims processing systems.
• Strong experience with medical claims adjudication including COB, subrogation, remittance processing, and claims editing platforms (e.g., ClaimLogic, ClaimsXten, or similar tools).
• Hands-on experience working within health plan core administration platforms such as TriZetto FACETS, QNXT, ika, PCM, or similar systems.
• Proficiency with SQL for backend validation, alongside experience in Agile/Scrum environments utilizing Jira, Azure DevOps, Rally, or similar project management tools.
• Strong understanding of ICD-10, CPT/HCPCS coding structures, modifier logic, and revenue codes.
• Excellent analytical, troubleshooting, documentation, and communication skills, with the ability to work independently in a fast-paced environment.

Nice To Haves

• Experience with pharmacy claims testing, Medicare Advantage claims processing, or PBM integrations.
• Familiarity with test automation and API testing tools including Selenium, Postman, and SOAP UI.
• Professional QA certifications such as ISTQB or CSTP.
• Bachelor’s degree in Computer Science, Information Systems, Healthcare Administration, or a related field (equivalent experience will be considered).

Responsibilities

• Design and execute comprehensive test plans, test cases, and test scripts for health plan claims processing systems.
• Validate end-to-end claims adjudication workflows including intake, pricing, benefit application, coordination of benefits (COB), payment processing, and EOB generation.
• Perform robust testing and validation of HIPAA-compliant EDI transaction sets including 837P/837I, 835, 270/271, 276/277, and 834 transactions.
• Verify claims payment accuracy against fee schedules, contracted provider rates, DRG/APR-DRG methodologies, per diem structures, and MAC pricing logic.
• Test auto-adjudication workflows, prior authorization integrations, manual review queues, and claims editing logic across core platforms.
• Lead defect triage, root cause analysis, regression testing, and release validation.
• Utilize SQL for deep-dive test data validation and backend verification activities.
• Ensure strict compliance with ACA, CMS, NCQA, HIPAA, state DOI mandates, and validate code set updates (ICD-10-CM/PCS, CPT, HCPCS, NDC, and revenue code tables).
• Partner with business analysts, claims operations, developers, and external trading partners to translate requirements into testable scenarios, while mentoring junior QA staff.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior