Software QA Analysts and Testers
Core
Develop and execute test plans, test cases, and scripts to validate pharmacy claims transactions, adjudication outcomes, eligibility, pricing, and interfaces within PBM environments.
Role type
Senior Software QA Analyst (Pharmacy Claims/PBM)
Builds
Validated pharmacy claims transactions, adjudication logic, and data integrity for PBM systems
Domain
Healthcare / Pharmacy Benefit Management (PBM)
Required skills
SQL, NCPDP D.0 and F6 standards, functional testing, regression testing, integration testing, API/interface testing, test data validation, defect management, business rule validation, workflow validation, batch process validation, end-to-end transaction testing, claim submission testing, adjudication testing, eligibility testing, benefits testing, pricing testing, accumulator testing, coverage determination testing, reject processing testing, UAT, production readiness validation, post-implementation defect analysis
Preferred skills
NCPDP standards migrations, payer sheet validation, transaction field mapping, experience working with PBM subject matter experts, business analysts, developers, business users, and downstream application teams
Technologies
SQL, API
Responsibilities
Analyze implementation requirements, transaction specifications, payer sheets, field mappings, and business rules to develop test scenarios and traceability. Create and execute test plans, test cases, scripts, and test data, and provide regression coverage for pharmacy claim transaction changes. Test claim transactions, adjudication outcomes, eligibility, coordination of benefits, pricing, accumulators, reject messaging, interfaces, and downstream impacts across functional, integration, UAT, parallel, and production testing. Perform SQL-based data validation, document and track defects, retest fixes, and work with business, PBM, development, and testing teams through implementation and release readiness.