- 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 Perks (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
📌 Technical Specialist-Testing Services (India)
🏢 Birlasoft
📍 India
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