Job Description:

Healthcare Domain - Member enrollment & eligibility — X12 834 maintenance, retro adjustments, deeming, 820 premium linkage, reconciliation across Medicaid/MA/Duals/MMP/TRICARE/Marketplace

Core Skills Needed - Facets (REQUIRED), X12 EDI (834, 820, 270/271), SQL, TOSCA, ADO, enrollment reconciliation

Core technical & domain requirements:

- Facets — REQUIRED: membership/enrollment module testing, subscriber/member configuration, and 834-to-Facets data flow validation
- X12 EDI: 834 (Benefit Enrollment & Maintenance) — full transaction expertise
- Member add/change/term, dependent handling, dual-enrollment scenarios
- Retroactive adjustments and deeming logic (Medicaid/MMP/Dual)
- 820 (Premium Payment) validation linkage
- Member eligibility cross-validation (270/271 correlation)
- Enrollment reconciliation: source system vs.



downstream (enrollment DB ↔ claims ↔ eligibility)
- SQL for member-level data comparisons (effective dates, plan codes, LOB flags)
- TOSCA or similar automation tool
- LOB knowledge: Medicaid, Medicare Advantage, Duals/MMP, TRICARE, Marketplace

Responsibilities:

- Design enrollment scenarios including retro, term, and dual-enrollment.
- Build/maintain automation; lead 820 linkage and 270/271 correlation testing.
- Lead reconciliation between 834 source and downstream member records.
- Own offshore enrollment test design across LOBs and deeming logic.
- Drive automation coverage and mentor analysts.
- Conduct RCA on eligibility and reconciliation discrepancies.

📌 SDET Engineer - Member enrollment & eligibility (India)
🏢 r3 Consultant
📍 India