Senior Test / QA Analyst
Bickham Services Unlimited, LLC•Huntington Beach, CA
•Remote
About The Position
Impresiv Health is seeking an experienced Senior Test / QA Analyst to support a West Coast healthcare client in a 4-month engagement focused on health plan claims processing systems. This role requires 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 experienced leading testing efforts across complex payer environments involving medical, pharmacy, and dental/vision claims.
Requirements
- 5 years of QA/testing experience, including at least 3 years supporting health plan claims processing systems.
- Strong experience with medical claims adjudication including COB, subrogation, remittance processing, and claims editing platforms such as ClaimLogic, ClaimsXten, or similar tools.
- Hands-on experience testing HIPAA EDI transactions including 837P/837I, 835, 276/277, and 270/271 transactions.
- Proficiency with SQL for test data validation and backend verification activities.
- Experience with health plan core administration platforms such as TriZetto FACETS, QNXT, ika, PCM, or similar systems.
- Experience working within Agile/Scrum environments utilizing Jira, Azure DevOps, Rally, or similar tools.
- Strong understanding of ICD-10, CPT/HCPCS coding structures, modifier logic, and revenue codes.
- Excellent analytical, troubleshooting, documentation, and communication skills.
- Bachelor?s degree in Computer Science, Information Systems, Healthcare Administration, or related field; equivalent experience considered.
Nice To Haves
- Experience with pharmacy claims testing, Medicare Advantage claims processing, or PBM integrations is preferred.
- Familiarity with test automation and API testing tools including Selenium, Postman, and SOAP UI is a plus.
- QA certifications such as ISTQB or CSTP are preferred.
Responsibilities
- Design, develop, and execute comprehensive test strategies, 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 testing and validation of HIPAA-compliant EDI transaction sets including 837, 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.
- Lead defect management activities including defect triage, root cause analysis, regression testing, and release validation.
- Partner with business analysts, claims operations teams, developers, and external trading partners to translate requirements into testable scenarios.
- Produce detailed test documentation including defect reports, traceability matrices, test summaries, and QA metrics dashboards.
- Support UAT coordination and release readiness activities across Agile and waterfall project environments.
- Ensure compliance with ACA, CMS, NCQA, HIPAA, state DOI mandates, and other applicable healthcare regulations.
- Validate code set updates including ICD-10-CM/PCS, CPT, HCPCS, NDC, and revenue code table refreshes.
- Mentor junior QA analysts and contribute to QA standards, frameworks, and best practices.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
