Senior QA Engineer - Facets & Medicaid Regulatory Solutions

Role: Senior QA Engineer - Facets & Medicaid Regulatory Solutions

Location: Remote

Experience: 8+ Year

Duration: Long Term

Rate: $50/hr

Role Summary

Seeking a Senior QA Engineer with strong Medicaid payer and Facets expertise to Consultantly validate state-specific regulatory implementations across Facets, Mainframe, Java, DataStage, Talend/TalendWorks, and associated applications.

Required Experience

• Strong healthcare payer QA/testing experience.
• Strong testing knowledge of TriZetto Facets.
• Testing experience across Mainframe and Java-based applications.
• Experience validating DataStage and Talend/TalendWorks processes.
• SQL and database testing skills.
• Strong Medicaid managed-care knowledge.
• Experience with state-specific Medicaid requirements.
• Good Medicare and Medicaid health-plan knowledge.
• Strong understanding of:

o Member enrollment

o Eligibility

o Benefits

o Claims

o Claims adjudication

o Pricing

o Payment

• Experience performing quality assessments for complex regulatory implementations.

Key Responsibilities

• Analyze Medicaid regulatory requirements and develop comprehensive test scenarios for individual states.
• Validate end-to-end changes across:

o Facets

o Mainframe

o Java applications

o DataStage

o Talend/TalendWorks

o APIs/interfaces

o Batch systems

o Upstream/downstream applications

• Test regulatory changes involving member enrollment, eligibility, benefits, claims adjudication, pricing, edits, and payments.
• Validate Mainframe and Java batch/interface processing.
• Perform ETL and source-to-target data validation.
• Conduct functional, integration, end-to-end, regression, negative, and boundary testing.
• Perform Consultant quality assessments of regulatory solutions.
• Identify gaps between regulatory requirements, requirements documentation, technical implementation, and actual system behavior.
• Perform SQL-based data validation and reconciliation.
• Conduct defect analysis and support root-cause investigation.
• Ensure traceability across Regulation Business Requirement System Change Test Scenario Test Result.

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