[Hiring] Senior PBM Pharmacy Claims QA Test Engineer @Cynet Systems

Role Description

The organization is looking for a Test Engineer with strong pharmacy claims and PBM testing experience to support an NCPDP D.0 to F6 implementation. This role is responsible for:

• Validating transaction changes
• Claim adjudication outcomes
• Eligibility and coordination of benefits scenarios
• Reject messaging
• Payer sheet impacts
• Data mapping
• Regression coverage
• Production readiness

The successful candidate has:

• Strong pharmacy claims testing experience
• Working knowledge of NCPDP D.0
• The ability to learn and validate F6 changes
• Strong SQL and data validation skills
• Experience collaborating with PBM Subject Matter Experts, Business Analysts, development, and business teams

Key experience includes:

• NCPDP D.0, NCPDP F6
• PBM/pharmacy claims
• SQL, SIT, UAT, Parallel, regression testing
• Trading partner testing, release testing, production validation
• Post-implementation defect triage

Qualifications

• Minimum of 7 years of Quality Assurance or software testing experience, preferably in healthcare, PBM or pharmacy claims environments
• Hands-on experience testing pharmacy claims, claim adjudication, eligibility, benefits, pricing, accumulators, reject codes, and claim response messaging
• Working knowledge of NCPDP Telecommunication Standard Version D.0; exposure to Version F6 implementation or standards migration is strongly preferred

Requirements

• PBM - Pharmacy Benefits Manager Domain knowledge is Mandatory
• Pharmacy Claims & PBM Domain Testing
• NCPDP D.0 / F6 Standards & Migration Validation
• Claim Adjudication, Eligibility, COB, Pricing & Reject Messaging
• Test Planning, Test Cases, Test Scripts, Traceability & Test Data
• Functional, SIT, UAT, Regression, Integration, E2E, Parallel, Release & Production Validation
• SQL, Backend Data Validation, Reconciliation & Claims Data Analysis
• Payer Sheet, Field Mapping, Business Rules & Transaction Specification Analysis
• Defect Management, Retesting, QA Reporting & Release Readiness
• SDLC, Agile/Scrum/Waterfall & Cross-functional Collaboration
• AI Tools for Test Automation

Responsibilities

• Analyze NCPDP D.0 and F6 implementation requirements, payer sheets, field mapping documents, business rules, and transaction specifications to identify test scenarios and validation needs
• Create and maintain test plans, test scenarios, test cases, test scripts, test data, and traceability for pharmacy claim transaction testing
• Analyze requirements and coordinate with Business Analysts and Subject Matter Experts
• Validate NCPDP pharmacy claim request and response transactions, including claim submission, reversal, eligibility, coordination of benefits, reject codes, messaging, pricing, accumulators, and coverage determination scenarios
• Perform functional, regression, integration, end-to-end, batch, database, API/interface, UAT support, Parallel and production validation testing for D.0 to F6 changes
• Develop and execute SQL queries to validate claims data, member eligibility, benefit setup, pricing, accumulators, drug data, payer configuration, and downstream reporting impacts
• Compare D.0 and F6 transaction behavior to confirm that new, modified, and retired fields are processed correctly across impacted systems
• Identify, document, track, retest, and close defects using approved defect management processes and tools
• Support test data creation for positive and negative scenarios
• Coordinate testing dependencies with PBM Subject Matter Experts, business users, developers, PBM teams, and downstream application teams
• Coordinate Onshore / Offshore activities as needed
• Utilize working knowledge of AI tools for automation
• Prepare daily or weekly status updates, defect reports, test execution metrics, test coverage summaries, and implementation risk updates
• Participate in requirement reviews, design walkthroughs, payer sheet reviews, field mapping reviews, release readiness meetings, and implementation checkpoints