QE Engineer - Encounter Data Processing

Job Description

Healthcare Domain - Encounter data processing X12 837 submissions to Medicaid/Medicare Advantage/TRICARE/Marketplace, acknowledgements, reconciliation, CMS & state companion guides

Core Skills Needed - Facets (REQUIRED), X12 EDI (837P/I/D, 277CA, 999/TA1), SQL, EDI validation tooling (Edifecs), TOSCA/Robot Framework/ Playwright

Core Technical & Domain Requirements

Facets REQUIRED: claims module familiarity (encounters are derived from Facets claims data); Facets-to-encounter data validation

X12 EDI knowledge: 837P, 837I, 837D (Skilled, Institutional, Dental) transaction structure, loops, segments

277CA (Claim Acknowledgement) and 999/TA1 validation

Encounter submission & acceptance rules Medicaid, Medicare Advantage, TRICARE, Marketplace

Edifecs or equivalent EDI validation tooling

SQL for encounter data validation (claim header, detail,



member eligibility cross-checks)

TOSCA or Robot Framework test automation

Healthcare payer domain: CMS encounter submission rules, state-specific companion guide

Responsibilities

Independently design encounter lifecycle scenarios across 837/277CA/999/TA1.

Build and maintain TOSCA/Robot Framework automation for encounter regression.

Lead reconciliation between source claims and submitted encounters.

Own encounter test design and submission-edit validation across LOBs.

Drive automation coverage and mentor analysts on EDI validation.

Conduct RCA on rejections and state/CMS edit failures.

"Education Qualification"

• Bachelor's degree in Computer Science, Engineering, or related field.

📌 QA Engineer (Bengaluru)
🏢 Ascendion
📍 Bengaluru