Role Overview• Responsible for test execution and validation across real-time pharmacy claims processing and adjudication systems.
- Collaborate with business SMEs, product owners, and engineering teams to ensure quality and compliance. Key Responsibilities:
- Analyze user needs and prepare test scenarios and test cases using Agile methodology • Create and maintain test artifacts for release testing (test cases, test data, execution results) • Participate in execution of release testing (SIT, regression, E2E) • Support test leads in meeting timelines and schedules for testing efforts • Execute test cases based on defined test plans and acceptance criteria • Follow and adhere to established QA standards, processes, and procedures • Communicate effectively with team members, stakeholders, and vendors as needed • Assist in test environment setup and validation activities • Follow standard testing methodologies and organizational QA frameworks • Participate in release-specific testing activities and coordination • Update and execute test cases and test data as per requirements • Participate in test case reviews, walkthroughs, and peer reviews • Support release validation and deployment verification activities • Contribute to lessons learned and continuous improvement initiatives • Identify, log,
and track defects through to closure • Work with BA/Dev teams to clarify requirements and resolve issues • Perform basic troubleshooting and issue analysis • Work both independently and collaboratively in a team environment Experience Required:
- Minimum of 4+ years of QA experience with PBM / pharmacy claims domain knowledge • Experience in writing SQL queries for data validation • Ability to design and execute test cases, test scenarios, and test data • Hands-on experience in validating end-to-end pharmacy claims lifecycle, including: o Member eligibility and benefit verification o Pharmacy/provider validation (NPI, NCPDP ID) o Real-time POS claims adjudication o Pricing logic (AWP, MAC, ingredient cost, dispensing fee, copay, accumulators) • Experience in testing scenarios involving: o Coordination of Advantages (COB) / Other Payer o Prior Authorization (PA) o Formulary and benefit plan rules o Specialty and retail pharmacy claims • Understanding of NCPDP standards (D.0; exposure to F6 preferred) • Ability to interpret business and technical requirements for testing Agile/Waterfall models • Good communication skills to report test results and defects clearly • Experience in web services/API testing using Postman or SoapUI • Basic knowledge of automation tools and testing practices • Strong interpersonal skills and ability to work with cross-functional teams