Project Role : Custom Software Engineer

Project Role Description : Develop custom software solutions to design, code, and enhance components across systems or applications. Use contemporary frameworks and agile practices to deliver scalable, high-performing solutions tailored to specific business needs.

Must have skills : Business Process Analysis

Positive to have skills : Test Automation Strategy

Minimum 3 Year(s) Of Experience Is Required

Educational Qualification : 15 years full time education

Claims/Data Specialist – BA/QA - Healthcare EDI

Experience - 5–10+ Years

Summary

BA/QA skilled bridging business and technology for healthcare claims and EDI integrations — ensuring accuracy, compliance, and data integrity across payer operations.

Responsibilities
BA - Requirements elicitation, user stories, process mapping, gap analysis, UAT support Agile ceremonies
Claims - End-to-end lifecycle — Intake, Adjudication, COB, Pricing, Payment, Appeals
EDI - 837P/I/D, 835, 277, 999, TA1, 270/271, 276/277, 278, 834
QA/Testing - Functional, Integration, E2E,



Data Validation, Regression, UAT
Data - SQL-based profiling, reconciliation, root cause analysis across claims systems and EDI gateways
Defects - Log, triage, manage through closure support release readiness and production validation

Required Skills Domain - U.S. Payer ops, Claims adjudication, HIPAA EDI, ICD-10, CPT, HCPCS, DRG Technical - Advanced SQL, EDI parsing, API testing (Postman/SoapUI), JSON/XML, Data mapping

Tools - JIRA Azure DevOps, qTest, SQL Server, Snowflake, Databricks, Power BI

Preferred: Facets, QNXT, HealthRules, Edifecs, TriZetto, FHIR/HL7, ISTQB/CBAP/CSM

Success Metrics - Fewer claim defects, Higher EDI acceptance, Better data quality, Faster releases

Additional Information -
The candidate should have minimum 5 years of experience in Business Process Analysis.
This position is based at our Hyderabad office.
A 15 years full time education is required.

📌 Custom Software Engineer Hyderabad (India)
🏢 Accenture in India
📍 India