Job Description
Project Description:
nYou will be part of a team responsible for testing healthcare claims processing, benefits, pricing, and related workflows for a non-profit healthcare organization in the US.
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nThe role is focused on validating local claims processing within HealthRules Payer (HRP), including EDI transactions, Blue Card claims, and HRP-to-TPA workflows.
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nYou will collaborate closely with Product Owners, Business Analysts, Developers, and QA team members across the US, India and Mexico.
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nResponsibilities:
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nPerform functional and end-to-end testing of healthcare claims processing within HealthRules Payer (HRP).
nValidate local claims processing workflows, business rules, advantages, pricing, and claims adjudication.
nTest and validate EDI 837 files and associated claims-processing workflows.
nPerform testing for Blue Card claims and related business scenarios.
nValidate HRP-to-TPA workflows, including upstream and downstream claims transactions.
nCreate and execute test cases and test scenarios based on business and functional requirements.




nAnalyze claims-processing results and identify inaccuracies or inconsistencies in business rules, configurations, pricing, and claim payments.
nDocument, track, retest, and support resolution of defects identified during testing.
nSupport investigation and resolution of production issues related to claims, benefits, and pricing configurations.
nParticipate in business requirements and solution-review sessions to identify testing requirements and potential gaps.
nCollaborate with business and IT teams to validate system changes, enhancements, and configuration updates before production deployment.
nProvide subject-matter expertise regarding healthcare claims processing and HRP workflows.
nMaintain appropriate testing and system documentation.
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nMandatory Skills:
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n- Healthcare Claims Processing
n- HealthRules Payer (HRP)
n- EDI 837
n- Blue Card
n- Healthcare Domain Knowl

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