Healthcare Claims Tester
Job Summary
Collaborating with cross-functional teams, the full-time remote Healthcare Claims Tester will validate healthcare claims processing workflows, including EDI transactions and Blue Card claims, while ensuring compliance with business rules and configurations.
Key responsibilities
- Perform functional and end-to-end testing of healthcare claims processing within HealthRules Payer (HRP)
- Create and execute test cases based on business and functional requirements, documenting and tracking defects identified during testing
- Collaborate with business and IT teams to validate system changes and support the resolution of production issues related to claims and benefits
Required qualifications
- 4+ years of experience in healthcare claims processing, operations, or claims testing
- Strong hands-on knowledge of local claims processing within HealthRules Payer (HRP) and EDI 837 files
- Experience with Blue Card claims processing and HRP-to-TPA workflows
- Bachelor's degree in Business Administration, Management Information Systems, Computer Science, or a related field, or equivalent relevant professional experience
- SQL knowledge for data validation and claims analysis
Complete Job Description
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