Job Description

Claims Adjudication Tester/Validator

Elite Technical is seeking a Claims Adjudication System Tester/Validator to join our clients Testing Department as an FTE employee. This position is responsible for developing system test plans, automated and manual test scripts, and test cases for functional and regression testing for health insurance claims processing systems and other support applications. Although this position is primarily remote, our client may request the selected candidate to come onsite, in the BWI Maryland area, when needed. We are seeking candidates that reside in the Maryland/DC/Virginia area. Primary responsibilities include:

- Primarily focusing on testing and validation for upgrades, add-ons and continued maintenance of the QNXT claims processing system;
- Works with Business Analysts (and others as needed) to ensure that test plans and scenarios cover all testable requirements and provides detailed feedback to the Information Technology staff related to application set-up or possible design flaws;
- Maintains detailed testing documentation including screen prints of system set-up and testing results, both good and bad;
- Reviews and/or develops reports as needed to ensure thorough testing as well as to identify trends in system issues;
- Identifies innovative methodologies to guarantee that tests are as fail-safe as possible and that potential fallout from fixes is tested;
- Documents details of bugs found during testing and notifies affected parties;
- Schedules status meetings as necessary to include all affected parties;
- Maintains and/or enhances system skills as needed to sustain a superior knowledge of the workflow, policies, procedures and system(s) capabilities.
- Works hours outside of normal work day/week when necessary. Able/willing to come onsite when necessary

Required Skills

- 2-4 years software testing experience or 5+ years of experience in testing methodology and practical application in a healthcare environment. A minimum of 3 years healthcare claims processing, specifically in FACETS is required.
- Thorough understanding of all aspects of Healthcare claims processing system - including (but not limited to) claim adjudication, membership and enrollment, eligibility, configuration and benefits, authorizations and payment is required
- This individual will have experience with transactional data including inbound and outbound HIPAA transactions, i.e. 834, 278, 837, 835 as well as proprietary files. Ability to read HIPAA transactions 278; 834; 835; 837I, P, D
- Knowledge of Claims Adjudication is required
- SQL experience is required
- Excellent verbal and written communication skills.
- Excellent problem solving and issue identification skills.
- Ability to work well independently.
- Proficiency with Microsoft Suite.
- Able to work hours outside of normal work day/week when necessary. Able to come onsite when necessary
- Experience and proficiency with claims editing software.

PREFERRED:
- Experience with the QNXT system is preferred.
- Experience and proficiency with Claim Test Pro a plus.
- Experience with automated test tools a plus.
- A.A. degree and professional industry certification preferred.

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Job Tags

Remote work

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