Must Have Technical/Functional Skills
• Strong SME knowledge in Healthcare Claims Processing lifecycle
• Expertise in EDI formats - 837 (P/I/D), 835, 834
• Hands-on experience in Facets (Claims + Enrollment modules)
• Proficiency in Azure DevOps (ADO) for QA tracking
• Knowledge of HIPAA compliance and payer systems
• 8+ years of experience in Healthcare QA/Testing
• 4+ years of experience as Test Lead in Facets projects
• Deep understanding of Claims Adjudication & Payment workflows
• Experience in handling claims denials, adjustments, and reprocessing
• Strong exposure to EDI claim and remittance transactions
• Experience in mocking and validating EDI files (837/835/834)
• Knowledge of ITS claims processing (SF, DF, RF)
• Experience in Member Enrollment workflows (Medicaid, Medicare, ACA)
• Understanding of Billing lifecycle for member enrollment
• Hands-on experience with ADO Test Plans, Test Suites, and Defect tracking
• Ability to perform data validation and reconciliation activities
• Strong experience in functional and end-to-end testinG
Familiarity with Agile/Scrum methodologies • Excellent stakeholder communication and coordination skills • Experience in risk identification, defect triage, and RCA
Roles & Responsibilities
• Lead end-to-end testing for Claims, Enrollment, and Billing modules
• Act as SME for Claims Processing and EDI transactions
• Validate Facets Claims and Membership workflows
• Design and execute test strategies, test plans, and test cases
• Perform EDI validation (837, 835, 834) including mock data creation
• Manage defect lifecycle, triage, and resolution tracking in ADO
• Ensure HIPAA compliance in all testing activities
• Validate ITS claims processing across SF, DF, RF flows
• Drive quality metrics, reporting, and release sign-offs
• Collaborate with business, development, and partner teams for E2E validation
Generic Managerial Skills, If any
• Leading and Mentoring team members
• Strong problem-solving and critical thinking
• Ability to work with minimal supervision
• Documentation and knowledge sharing
• Excellent communication
Key Words to search in Resume
• EDI claims
• EDI files (837 , 835, 834)
• Facets
• Claims
• Member Enrollment
• Billing lifecycle
• Azure DevOps (ADO)
• HIPAA compliance
• Healthcare QA, Testing
• Test Lead
• Claims Adjudication
• Payment workflows
• ITS
Pre-Screening Questionnaire
• Do you have 7+ years of Healthcare QA/Testing experience?
• Do you have experience as a QA/Test lead , leading and mentoring team members?
• Do you have experience with Facets including Claims, Enrollment, and Billing modules?
• Do you have experience in EDI validation (837, 835, 834) including mock data creation?
• Do you have experience in Claims Processing ?
• Do you have experience in ITS claims processing ?
• Have you managed defect lifecycle, triage, and resolution tracking in ADO?
• Have you been responsible for quality metrics, reporting, and release sign-offs?
• Have you collaborated with business, development, and partner teams for E2E validation?
*What are Regulated Positions
"Regulated Positions" are those positions which requires TAG to recruit candidates with specific work
authorizations viz., US Citizens (or) US Persons only as these may be regulated by any of the below listed
per MSA.
- ITAR (International Traffic in Arms Regulations).
- NERC CIP (NERC Critical Infrastructure Protection).
- NRC (Nuclear Regulatory Commission).
- Any other regulations as appropriate.
Role Descriptions: Functional testingFacets Claims testing Pricing claims and Alliance claim pricing testing SQL/DB testing| Automation
Essential Skills: Functional testingFacets Claims testing Pricing claims and Alliance claim pricing testing SQL/DB testing| Automation
Desirable Skills:
Keyword:
Skills: Functional Testing
Experience Required: 8-10, Project Code :
• Strong SME knowledge in Healthcare Claims Processing lifecycle
• Expertise in EDI formats - 837 (P/I/D), 835, 834
• Hands-on experience in Facets (Claims + Enrollment modules)
• Proficiency in Azure DevOps (ADO) for QA tracking
• Knowledge of HIPAA compliance and payer systems
• 8+ years of experience in Healthcare QA/Testing
• 4+ years of experience as Test Lead in Facets projects
• Deep understanding of Claims Adjudication & Payment workflows
• Experience in handling claims denials, adjustments, and reprocessing
• Strong exposure to EDI claim and remittance transactions
• Experience in mocking and validating EDI files (837/835/834)
• Knowledge of ITS claims processing (SF, DF, RF)
• Experience in Member Enrollment workflows (Medicaid, Medicare, ACA)
• Understanding of Billing lifecycle for member enrollment
• Hands-on experience with ADO Test Plans, Test Suites, and Defect tracking
• Ability to perform data validation and reconciliation activities
• Strong experience in functional and end-to-end testinG
Familiarity with Agile/Scrum methodologies • Excellent stakeholder communication and coordination skills • Experience in risk identification, defect triage, and RCA
Roles & Responsibilities
• Lead end-to-end testing for Claims, Enrollment, and Billing modules
• Act as SME for Claims Processing and EDI transactions
• Validate Facets Claims and Membership workflows
• Design and execute test strategies, test plans, and test cases
• Perform EDI validation (837, 835, 834) including mock data creation
• Manage defect lifecycle, triage, and resolution tracking in ADO
• Ensure HIPAA compliance in all testing activities
• Validate ITS claims processing across SF, DF, RF flows
• Drive quality metrics, reporting, and release sign-offs
• Collaborate with business, development, and partner teams for E2E validation
Generic Managerial Skills, If any
• Leading and Mentoring team members
• Strong problem-solving and critical thinking
• Ability to work with minimal supervision
• Documentation and knowledge sharing
• Excellent communication
Key Words to search in Resume
• EDI claims
• EDI files (837 , 835, 834)
• Facets
• Claims
• Member Enrollment
• Billing lifecycle
• Azure DevOps (ADO)
• HIPAA compliance
• Healthcare QA, Testing
• Test Lead
• Claims Adjudication
• Payment workflows
• ITS
Pre-Screening Questionnaire
• Do you have 7+ years of Healthcare QA/Testing experience?
• Do you have experience as a QA/Test lead , leading and mentoring team members?
• Do you have experience with Facets including Claims, Enrollment, and Billing modules?
• Do you have experience in EDI validation (837, 835, 834) including mock data creation?
• Do you have experience in Claims Processing ?
• Do you have experience in ITS claims processing ?
• Have you managed defect lifecycle, triage, and resolution tracking in ADO?
• Have you been responsible for quality metrics, reporting, and release sign-offs?
• Have you collaborated with business, development, and partner teams for E2E validation?
*What are Regulated Positions
"Regulated Positions" are those positions which requires TAG to recruit candidates with specific work
authorizations viz., US Citizens (or) US Persons only as these may be regulated by any of the below listed
per MSA.
- ITAR (International Traffic in Arms Regulations).
- NERC CIP (NERC Critical Infrastructure Protection).
- NRC (Nuclear Regulatory Commission).
- Any other regulations as appropriate.
Role Descriptions: Functional testingFacets Claims testing Pricing claims and Alliance claim pricing testing SQL/DB testing| Automation
Essential Skills: Functional testingFacets Claims testing Pricing claims and Alliance claim pricing testing SQL/DB testing| Automation
Desirable Skills:
Keyword:
Skills: Functional Testing
Experience Required: 8-10, Project Code :