QA Specialist

Job Summary

This role is for a QA Analyst who will help test configuration, benefits, pricing, and claims adjudication work inside a healthcare payer setting. The position focuses on building and running test plans, checking configuration updates, logging defects, and confirming that the system behaves as expected from a business perspective.

The right candidate should already know healthcare payer operations and have a solid grasp of claims processing. Strong value will be placed on someone who can tell the difference between a configuration problem, a claims adjudication issue, and other defects discovered during testing.

Primary Responsibilities

• Carry out functional, integration, regression, and user acceptance testing.
• Review and verify changes made to claims administration configuration and related enhancements.
• Create and run test cases, test scenarios, and test scripts.
• Evaluate test outcomes and record defects in a clear, accurate way.
• Check claims adjudication results against the applicable business rules.
• Partner with configuration teams, business analysts, developers, and business stakeholders to troubleshoot and close issues.
• Join requirement reviews and give input on testability and risk areas.
• Assist with release testing and validation of production fixes or changes.
• Keep testing records and metrics up to date.

Education and Experience

This position calls for at least 3 years of QA or software testing experience in a healthcare payer environment. Hands-on experience with claims processing systems is required, along with a strong understanding of claims adjudication and payer workflows.

Additional experience that strengthens the fit includes writing and executing test cases, documenting defects, analyzing results to find the root cause, and communicating findings clearly. Exposure to HealthRules Payer (HRP) implementations or enhancements is also important, as is experience validating claims, benefits, provider, and reimbursement configurations.

Knowledge of healthcare claim pricing and payment methods, familiarity with Medicare, Medicaid, Commercial, or Managed Care products, and experience using defect tracking and test management tools are all relevant to the role.

Work Context

This is a remote contract position based out of Boston, MA.