Job Summary

We are seeking a Senior Healthcare Claims Data Validation Analyst with extensive experience in healthcare claims processing, data validation, and manual testing. The ideal candidate will be responsible for validating healthcare claims data, ensuring accuracy across systems, identifying processing defects, and supporting end-to-end claims lifecycle testing. Automation testing experience is a plus but not mandatory.

Key Responsibilities

- Perform comprehensive manual testing of healthcare claims processing applications.
- Validate medical, dental, pharmacy, and provider claims data across multiple systems.
- Review claim adjudication results, eligibility, benefits, pricing, and payment calculations.
- Analyze source-to-target data mappings and validate data transformations.
- Execute test cases and document test results, defects, and remediation activities.
- Verify HIPAA-compliant transactions including 837, 835, 270/271, and EDI files.
- Conduct data reconciliation between upstream and downstream systems.
- Collaborate with business analysts, developers, and claims SMEs to understand requirements.
- Participate in SIT, UAT, regression, and production validation activities.
- Create detailed test plans, test scenarios, and traceability matrices.
- Investigate claim processing issues and support root cause analysis.

Required Qualifications





- 8+ years of experience in Healthcare Claims Processing and QA Testing.
- Strong knowledge of healthcare payer systems and claim adjudication.
- Hands-on experience in manual testing and data validation.
- Experience validating healthcare data using SQL queries.
- Understanding of HIPAA regulations and EDI transactions.
- Experience with defect management tools such as Jira or Azure DevOps.
- Solid analytical and problem-solving skills.

Preferred Qualifications

- Automation testing experience using Selenium, Playwright, UFT, or similar tools.
- Experience with ETL testing and database validation.
- Knowledge of Agile/Scrum methodologies.
- Exposure to cloud platforms such as Azure or AWS.

Required Skills

- Healthcare Claims Processing
- Claims Adjudication
- Data Validation
- Manual Testing
- SQL
- EDI / HIPAA Transactions
- Defect Tracking (Jira, ADO)
- UAT, SIT, Regression Testing
- Root Cause Analysis

Preferred Skills

- Selenium Automation
- Playwright
- API Testing
- ETL Testing
- Azure DevOps

Suggested Job Titles:

- Senior Healthcare Claims QA Analyst
- Senior Healthcare Claims Data Validation Analyst
- Senior Manual QA Analyst (Healthcare Claims)
- Healthcare Claims Testing Lead
- Senior Claims Adjudication QA Consultant

📌 Senior Healthcare Claims Data Validation Analyst (Manual QA)-India(Remote)
🏢 PEER IT SOL
📍 Pushkar