Healthcare Claims Tester - ACAS - 3+ Years - Pan India

Are you an experienced US Healthcare Claims Tester with hands-on expertise in ACAS and Claims Adjudication? This opportunity is for professionals who have experience in end-to-end healthcare claims testing and a strong understanding of US healthcare insurance processes.

You will be responsible for validating claims adjudication, benefit application, pricing logic, payment calculations, and claims-related workflows while ensuring that business requirements are accurately implemented.

Location - Gurgaon / Bengaluru / Hyderabad / Pune / Mumbai

Your Future Employer

Join a professional workplace where you will work on US Healthcare Claims Testing and Adjudication processes, collaborate with business and technical stakeholders, and contribute to quality assurance across healthcare claims platforms.

Responsibilities

1. Perform end-to-end testing of healthcare claims processed through the ACAS platform.
2. Validate claim adjudication outcomes, pricing logic, payment calculations, and benefit application.
3. Execute test cases covering overpayment recovery, refund processing, and claims rework workflows.
4. Validate payment integrity edits and ensure accurate implementation of business requirements.
5. Perform regression, integration, system, and UAT testing.
6. Review and validate member, provider, claim, and benefit attributes.
7. Analyze test results, identify defects, document findings, and coordinate with development teams for resolution.
8. Support release validation, production verification, and post-implementation testing activities.
9. Collaborate with business stakeholders to understand requirements and create comprehensive test scenarios.
10. Prepare test plans, test cases, traceability matrices, and test execution reports.

Requirements

1. 37 years of experience in US Healthcare Claims Testing.
2. Hands-on experience with ACAS (Aetna Claims Adjudication System).
3. Mandatory experience working on an Aetna client/project.
4. Experience with ACAS / Rumba.
5.



Strong understanding of Claims Testing and Claims Adjudication.
6. Experience with Member Enrollment, Provider Validation, and Benefit Configuration.
7. Knowledge of Professional and Institutional claims.
8. Experience with Medicare, Medicaid, and Commercial healthcare plans.
9. Strong understanding of Deductible, Copay, Coinsurance, and Out-of-Pocket calculations.
10. Strong defect management and testing skills.
11. Bachelors Degree / Postgraduate Degree.

What is in it for you?

1. Opportunity to work on US Healthcare Claims Testing and Adjudication.
2. Exposure to the ACAS platform and healthcare claims processes.
3. Opportunity to work with cross-functional business and technology teams.
4. Exposure to complex claims, benefits, payment, and adjudication scenarios.
5. Opportunity to build deeper expertise in the US Healthcare domain.

Reach us - If you think this role is aligned with your career, kindly write to us along with your updated CV on [email protected] for a confidential discussion on the role.

Disclaimer - Crescendo Global specializes in Senior to C-level niche recruitment. We are passionate about empowering job seekers and employers with an engaging, memorable job search and leadership hiring experience. Crescendo Global does not discriminate on the basis of race, religion, color, origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Note - We receive a large number of applications on a daily basis, so it may be difficult for us to get back to every candidate. Please assume that your profile has not been shortlisted if you do not hear back from us within 1 week. Your patience is highly appreciated.

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📌 Healthcare Claims Tester - ACAS - 3+ years - Pan India (Hyderabad)
🏢 Crescendo Global Leadership Hiring India
📍 Hyderabad