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Full-time
Posted 4d ago
Apply by Aug 14
~40 hrs/week
Responsibilities
The Technical Specialist is responsible for executing and validating real-time pharmacy claims processing and adjudication systems. They will collaborate with cross-functional teams to ensure quality compliance while managing test artifacts and defect tracking throughout the release lifecycle.
Requirements
Candidates must have at least 4 years of QA experience with specific knowledge of the PBM and pharmacy claims domain. Proficiency in SQL, API testing tools, and understanding of NCPDP standards is required to perform end-to-end testing and validation.
Full job description
Area(s) of responsibility
QA Analyst Job Description
Role Overview • Responsible for test execution and validation across real-time pharmacy claims processing and adjudication systems. • Collaborate with business SMEs, product owners, and engineering teams to ensure quality and compliance.
Key Responsibilities: • Analyze user needs and prepare test scenarios and test cases using Agile methodology • Create and maintain test artifacts for release testing (test cases, test data, execution results) • Participate in execution of release testing (SIT, regression, E2E) • Support test leads in meeting timelines and schedules for testing efforts • Execute test cases based on defined test plans and acceptance criteria • Follow and adhere to established QA standards, processes, and procedures • Communicate effectively with team members, stakeholders, and vendors as needed • Assist in test environment setup and validation activities • Follow standard testing methodologies and organizational QA frameworks • Participate in release-specific testing activities and coordination • Update and execute test cases and test data as per requirements • Participate in test case reviews, walkthroughs, and peer reviews • Support release validation and deployment verification activities • Contribute to lessons learned and continuous improvement initiatives • Identify, log, and track defects through to closure • Work with BA/Dev teams to clarify requirements and resolve issues • Perform basic troubleshooting and issue analysis • Work both independently and collaboratively in a team environment
Experience Required: • Minimum of 4+ years of QA experience with PBM / pharmacy claims domain knowledge • Experience in writing SQL queries for data validation • Ability to design and execute test cases, test scenarios, and test data • Hands-on experience in validating end-to-end pharmacy claims lifecycle, including: o Member eligibility and benefit verification o Pharmacy/provider validation (NPI, NCPDP ID) o Real-time POS claims adjudication o Pricing logic (AWP, MAC, ingredient cost, dispensing fee, copay, accumulators) • Experience in testing scenarios involving: o Coordination of Benefits (COB) / Other Payer o Prior Authorization (PA) o Formulary and benefit plan rules o Specialty and retail pharmacy claims • Understanding of NCPDP standards (D.0; exposure to F6 preferred) • Ability to interpret business and technical requirements for testing Agile/Waterfall models • Good communication skills to report test results and defects clearly • Experience in web services/API testing using Postman or SoapUI • Basic knowledge of automation tools and testing practices • Strong interpersonal skills and ability to work with cross-functional teams
Navigating Change. Powering Progress. | Reimagining the Future with Birlasoft
Birlasoft, a powerhouse where domain expertise, enterprise solutions, and digital technologies converge to redefine business processes. We take pride in our consultative and design thinking approach, driving societal progress by enabling our customers to run businesses with unmatched efficiency and innovation. As part of the CKA Birla Group, a multibillion-dollar enterprise, we boast a 12,000+ professional team committed to upholding the Group's 170-year legacy. Our core values prioritize Diversity, Equity, and Inclusion (DEI) initiatives, along with Corporate Social Responsibility (CSR) activities, demonstrating our dedication to building inclusive and sustainable communities. Join us in shaping a future where technology seamlessly aligns with purpose.
For further information, visit www.birlasoft.com
Offices: 35 & 36, Rajiv Gandhi Infotech Park, Phase - I, Hinjawadi MIDC, Pune, Maharashtra 411057, IN · The Assotech Business Cresterra Tower 3, Plot No. 22, Noida-Greater Noida Expressway, Sector 135, Noida, UP 201306, IN · 4th Floor, 53-54 Grosvenor Street, London, London W1K 3HU, GB · Building A, Plot No. EL-207/1, MIDC,, TTC Industrial Area, Mahape Road, Mahape,, Navi Mumbai, Maharashtra 400710, IN · Tower 2.1, Level 15 & 16, TSI Business Park, Waverock Project, APIIC IT/ITES SEZ,, Nanakramguda Village, Serillingampally Mandal, Ranga Reddy District, Hyderabad, Telangana 500008, IN
Enterprise Application ServicesApplication Development and MigrationQuality Assurance and Testing ServicesERP and CRM ServicesMobility ServicesAdvanced Analytics ServicesCloud ServicesContent Management SolutionsIntegrated Management ServicesTesting as a Service
Navigating Change. Powering Progress. | Reimagining the Future with Birlasoft
Birlasoft, a powerhouse where domain expertise, enterprise solutions, and digital technologies converge to redefine business processes. We take pride in our consultative and design thinking approach, driving societal progress by enabling our customers to run businesses with unmatched efficiency and innovation. As part of the CKA Birla Group, a multibillion-dollar enterprise, we boast a 12,000+ professional team committed to upholding the Group's 170-year legacy. Our core values prioritize Diversity, Equity, and Inclusion (DEI) initiatives, along with Corporate Social Responsibility (CSR) activities, demonstrating our dedication to building inclusive and sustainable communities. Join us in shaping a future where technology seamlessly aligns with purpose.
For further information, visit www.birlasoft.com
Offices: 35 & 36, Rajiv Gandhi Infotech Park, Phase - I, Hinjawadi MIDC, Pune, Maharashtra 411057, IN · The Assotech Business Cresterra Tower 3, Plot No. 22, Noida-Greater Noida Expressway, Sector 135, Noida, UP 201306, IN · 4th Floor, 53-54 Grosvenor Street, London, London W1K 3HU, GB · Building A, Plot No. EL-207/1, MIDC,, TTC Industrial Area, Mahape Road, Mahape,, Navi Mumbai, Maharashtra 400710, IN · Tower 2.1, Level 15 & 16, TSI Business Park, Waverock Project, APIIC IT/ITES SEZ,, Nanakramguda Village, Serillingampally Mandal, Ranga Reddy District, Hyderabad, Telangana 500008, IN
Enterprise Application ServicesApplication Development and MigrationQuality Assurance and Testing ServicesERP and CRM ServicesMobility ServicesAdvanced Analytics ServicesCloud ServicesContent Management SolutionsIntegrated Management ServicesTesting as a Service