Job Description
- Should have strong MMIS health care domain experience and should have good knowledge of Medicaid and Medicare.
- Should have hands-on experience on claims processing and Adjudication processes.
- Must have good experience in Reference code/data sets required in Claims adjudication.
- Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
- In depth understanding of Claims and Claims lifecycle Claim System:
- 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 case based on business rules, coverage policies, and system configurations.
- Familiarity with test management tools like ADO, JIRA,
- Interface/API testing tools like Postman Technical Skills
- SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).
- - EDI Tools: Validating X12 files.
- - Interface Testing: Understanding how data flows between systems and formats and use tools like postman
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