About this role
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.