Title:  Technical Specialist-Testing Services

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