osition: Senior QA Engineer – Facets & Medicaid Regulatory Solutions
Location: Remote
Mandatory-Domain expectations across all roles
Medicaid Regulatory & Payer Domain & Technology Expertise:
Candidates should have strong knowledge of Medicaid managed-care operations and experience working with state-specific Medicaid requirements. They should understand how regulatory changes affect member enrollment/eligibility, coverage, claim processing, authorization, pricing/payment, data and downstream health-plan operations. They should also possess a good working understanding of Medicare and Medicare-Medicaid processes.
Candidates must have experience delivering healthcare payer solutions across a combination of TriZetto Facets, Mainframe, Java/J2EE, IBM DataStage, Talend/TalendWorks, databases, batch processing, APIs and system integrations. Candidates should have strong knowledge of Medicaid managed-care processes and state-specific regulatory requirements, together with a good understanding of Medicare and Medicaid health-plan operations, particularly member enrollment, eligibility, benefits, claims adjudication, pricing and payment.
Primary Skills
Strong Facets + Medicaid + end-to-end cross-platform testing, with ability to validate Mainframe/Java/ETL processing.
Role Summary
Seeking a Senior QA Engineer with strong Medicaid payer and Facets expertise to independently validate state-specific regulatory implementations across Facets, Mainframe, Java, DataStage, Talend/TalendWorks, and associated applications.
Key Responsibilities
· Analyze Medicaid regulatory requirements and develop comprehensive test scenarios for individual states.
· Validate end-to-end changes across:
Facets
Mainframe
Java applications
DataStage
Talend/TalendWorks
APIs/interfaces
Batch systems
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 independent 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.
· 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:
Member enrollment
Eligibility
Benefits
Claims
Claims adjudication
Pricing
Payment
· Experience performing quality assessments for complex regulatory implementations.