Note: The job is a remote job and is open to candidates in USA. Infinite Computer Solutions is seeking a QA Functional Analyst with PBM and pharmacy claims testing expertise. The role validates NCPDP D.0 to F6 transaction changes, claim adjudication, eligibility, coordination of benefits, data mappings, regression coverage, and production readiness while collaborating with business, development, PBM, and downstream application teams.
Responsibilities
- Analyze NCPDP D.0 and F6 implementation requirements, payer sheets, field mapping documents, business rules, and transaction specifications to identify test scenarios and validation needs
- Create and maintain test plans, test scenarios, test cases, test scripts, test data, and traceability for pharmacy claim transaction testing
- Analyzes requirements, coordinate with BA’s / Subject Matter Experts
- Validate NCPDP pharmacy claim request and response transactions, including claim submission, reversal, eligibility, coordination of benefits, reject codes, messaging, pricing, accumulators, and coverage determination scenarios
- Perform functional, regression, integration, end-to-end, batch, database, API/interface, UAT support, Parallel and production validation testing for D.0 to F6 changes
- Develop and execute SQL queries to validate claims data, member eligibility, benefit setup, pricing, accumulators, drug data, payer configuration, and downstream reporting impacts
- Compare D.0 and F6 transaction behavior to confirm that new, modified, and retired fields are processed correctly across impacted systems
- Identify, document, track, retest, and close defects using approved defect management processes and tools
- Support test data creation for positive, negative scenarios
- Coordinate testing dependencies with PBM SME’s, business users, developers, PBM teams, and downstream application teams
- Coordinates Onshore / Offshore as needed
- Working knowledge on AI tools for automation
- Prepare daily or weekly status updates, defect reports, test execution metrics, test coverage summaries, and implementation risk updates
- Participate in requirement reviews, design walkthroughs, payer sheet reviews, field mapping reviews, release readiness meetings, and implementation checkpoints
Skills
- Minimum of 7 years of Quality Assurance or software testing experience, preferably in healthcare, PBM or pharmacy claims environments
- Hands-on experience testing pharmacy claims, claim adjudication, eligibility, benefits, pricing, accumulators, reject codes, and claim response messaging
- Working knowledge of NCPDP Telecommunication Standard Version D.0; exposure to Version F6 implementation or standards migration is strongly preferred
- Experience creating test plans, test cases, test scripts, test estimates, test data, and traceability matrices
- Strong understanding of SDLC methodologies, including Agile, Scrum, Waterfall, Iterative, or hybrid delivery models
- Solid SQL experience for backend validation, data reconciliation, and claims data analysis
- Experience with defect management, test execution tracking, QA reporting, and release validation
- Ability to interpret transaction layouts, payer sheets, field-level requirements, business rules, and technical mapping documents
- Strong analytical, troubleshooting, organizational, documentation, and problem-solving skills
- Effective written and verbal communication skills with the ability to explain testing results, defects, and implementation risks to technical and business audiences
- Ability to work independently and collaboratively in a fast-paced implementation environment
- Equivalent industry experience may be considered
- Bachelor's degree is preferred
Benefits
- Remote work arrangement
- Full-time W-2 employment
Company Overview
Company H1B Sponsorship