Responsibilities
- Lead end-to-end QA activities for RxCLAIM-based applications, including test strategy, planning, execution, and defect management
- Act as the QA point of contact for PBM/RxCLAIM initiatives, collaborating closely with business analysts, developers, and product owners
- Define and enforce QA processes, standards, and best practices across projects
- Review and validate business requirements, functional specifications, and technical designs from a QA perspective
- Design and oversee test scenarios, test cases, and test data covering eligibility, claims adjudication, pricing, formularies, benefits, accumulators, and prior authorization
- Lead and mentor QA analysts, providing guidance on RxCLAIM workflows and testing techniques
- Coordinate SIT, UAT, and regression testing, including support for business and client UAT cycles
- Ensure compliance with healthcare regulations and industry standards (HIPAA, CMS, etc.)
- Track test execution metrics, defect trends, and quality KPIs; report status to stakeholders
- Support automation initiatives by identifying regression candidates and working with automation teams
- Participate in release planning, production validation, and post-release defect analysis
Requirements
- 8+ years of experience in QA/testing, with at least 3–4 years in a QA Lead role
- Strong hands-on experience with RxCLAIM (claims processing, plan setup, pricing, benefits, accumulators, DUR, PA)
- Solid understanding of PBM and pharmacy domain concepts
- Strong knowledge of test management and defect tracking tools (e.g., ALM, Jira, Zephyr, qTest)
- Excellent analytical, problem-solving, and communication skills
- Proven experience leading teams and coordinating with cross-functional stakeholders
Nice to Have
- Experience with test automation tools and frameworks
- Exposure to other PBM platforms (e.g., QNXT, Facets, ICD)
- Experience working in Agile/Scrum environments
- ISTQB or similar QA certification
