[Hiring] Manager, IT Testing @Conduent State Healthcare, LLC

Role Description

Play the role of Claims Domain test manager for MMIS health care projects. Drive the test strategy and process, domain knowledge, perform analysis of business requirements, design and develop test plans, ensure quality process, coordinates with customers on delivery and deployments. Works in team environment and provides testing guidance throughout the entire life cycle. Responsible to meet customer expectations, troubleshoot problems in the application and assisting customers in implementation decisions.

Qualifications

• Strong health care domain experience, particularly in Medicaid and Medicare.
• Hands-on experience in claims processing and adjudication processes.
• Experience with reference code/data sets required in claims adjudication.
• Prior experience or understanding in configuring benefits or programs in claims systems across various sub-systems.
• Ability to run queries and perform basic system analysis, RCA, etc.
• Excellent written and spoken communication skills.
• Ability to multitask between internal teams and clients based on priority tasks.
• In-depth understanding of claims and claims lifecycle.

Requirements

• Familiarity with claim types: Professional, Dental, Institutional, Pharmacy, Encounters, and Capitation.
• Familiarity with claim formats: EDI X12 formats like 837P/I/D, X12 formats 835, 834, 270/271, 276/277.
• Familiarity with systems like CMdS, GHS, Facets, etc.
• Testing knowledge and E2E Testing: Validate the entire flow from claim intake to payment and reporting.
• Interface testing: Test integration points between systems.
• Design test cases based on business rules, coverage policies, and system configurations.
• Familiarity with test management tools like ADO, JIRA.
• Interface/API testing tools like Postman.
• Minimum of 10+ years of experience in health care, especially in MMIS domain.
• SQL skills to validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).
• Understanding of EDI tools for validating X12 files.
• Capability to think out-of-the-box to create new solutions as needed.
• Ability to validate test scenarios and test plans, test data.
• Review requirements, documentation, and create Requirements Traceability Matrix (RTM).
• Excellent communication skills to engage with different stakeholders like QA/dev team, clients, end users, and business units.
• Ability to assess current functionality available in a product vis-a-vis market trends and regulatory requirements.
• Ability to drive and share requirements with Technical and Architects regarding product features to be implemented.
• Test Planning & Reporting: Create test plans, test summary reports, and traceability matrices.
• Collaborate with cross-functional teams including developers, SMEs, and BAs.

Benefits

• Health insurance coverage.
• Voluntary dental and vision programs.
• Life and disability insurance.
• Retirement savings plan.
• Paid holidays.
• Paid time off (PTO) or vacation and/or sick time.