The Quality Assurance Engineer will partner closely with IT, Operations, Configuration, EDI, Reporting, Business Analysts, and other cross-functional stakeholders to ensure system changes are thoroughly tested prior to deployment. This position plays a critical role in validating system functionality, configuration changes, integrations, data flows, operational workflows, and enhancements that support HN1's managed care operations and transformation initiatives.
Key Responsibilities
Testing Environment Management
Design, build, and maintain non-production testing environments that accurately replicate end-to-end managed care workflows and system interactions.
Develop and maintain test data libraries representing a broad range of managed care scenarios, including provider, member, eligibility, authorization, referral, claims, pricing, payment, reporting, and data exchange workflows.
Establish processes for refreshing, validating, and governing test data while maintaining regulatory and privacy compliance.
Coordinate environment readiness and testing schedules across multiple projects and releases.
Monitor testing environments to ensure availability, stability, and data integrity.
Test Planning and Execution
Develop comprehensive test strategies, test plans, test scripts, and test cases for system enhancements, APIs, interfaces, system integrations, regulatory workflows, and production fixes.
Execute functional, regression, integration, user acceptance, and end-to-end testing.
Validate system logic, master data, configuration, benefit rules, provider data, authorization and referral workflows, claims adjudication, payment processes, reporting outputs, and downstream integrations.
Verify system behavior against documented business requirements and operational specifications.
Develop and execute test cases for APIs, interfaces, and system integrations to validate data exchange, system connectivity, and end-to-end processing accuracy.
Apply risk-based testing methodologies to prioritize testing activities based on business impact, operational risk, and regulatory requirements.
Validate compliance-related functionality associated with HIPAA, CMS requirements, interoperability mandates, delegated services, and other regulatory requirements as applicable.
Defect Management
Identify, document, prioritize, and track defects through resolution.
Collaborate with developers, analysts, and operational stakeholders to investigate root causes and validate fixes.
Retest defects and verify successful remediation prior to production deployment.
Collaboration and Process Improvement
Serve as a primary liaison between IT and operational teams during testing activities, ensuring business processes are accurately reflected in test scenarios.
Partner with business stakeholders to understand operational workflows and translate requirements into testing scenarios.
Recommend improvements to QA methodologies, testing tools, test automation opportunities, and release management processes.
Design, develop, and maintain automated test scripts to improve testing efficiency, repeatability, and coverage across key business and technical workflows.
Support production issue investigations and post-implementation validation activities.
Reporting and Documentation
Provide regular testing status updates, risk assessments, and defect summaries to project teams and leadership.
Maintain testing standards, procedures, and documentation repositories.
Develop QA metrics and dashboards to measure testing effectiveness and release quality.
Required Qualifications
Education
Bachelor's degree in Information Technology, Computer Science, Information Systems, Healthcare Administration, Business, or a related field, or equivalent work experience.
Experience
3+ years of software quality assurance or software testing experience.
Experience supporting healthcare technology platforms, managed care operations, payer systems, provider network systems, claims processing platforms, or related enterprise applications.
Experience creating test plans, test scripts, and executing structured testing methodologies.
Experience working in Agile, Waterfall, or hybrid project environments.
Experience with healthcare interoperability standards including FHIR, HL7, X12, and API-based integrations.
Experience validating CMS interoperability and prior authorization workflows.
Knowledge, Skills, and Abilities
Strong understanding of software development lifecycle (SDLC) and quality assurance practices.
Knowledge of managed care operations, payer systems, provider data management, eligibility, authorization, referral, claims, reporting, or healthcare operational workflows preferred.
Strong analytical and problem-solving skills.
Excellent attention to detail and documentation capabilities.
Ability to manage multiple priorities and deadlines simultaneously.
Strong verbal and written communication skills.
Ability to collaborate effectively with technical and non-technical stakeholders.
Proficiency with Microsoft Office Suite, particularly Excel.
Technical familiarity with APIs, interfaces, and system integrations.
Working knowledge of SQL for data validation, troubleshooting, and root cause analysis.
Experience using defect tracking and test management tools.
Preferred Qualifications
Experience with managed care, payer administration, provider network, care management, authorization, claims, or related healthcare enterprise platforms.
Experience with SQL and database validation.
Experience with test automation tools.
Experience with AI-enabled testing tools.
Knowledge of EDI transactions, including 837 and 835 files.
Healthcare payer, TPA, managed care, delegated services, provider network, utilization management, or specialty benefit management experience.
QA certifications such as ISTQB, CSTE, or equivalent.
Location:
Position is remote and the location of candidate is flexible within the U.S.