Key Responsibilities:
• EDI Expertise: Develop test cases/scenarios for Facets and EDI-X12 transactions (837, 834, 835, etc.,). Validate X12 segment and looping structure against healthcare standards, including HIPAA and SNIP level validations.
• Health Insurance Knowledge: Strong understanding of health insurance processes like claims and enrollment.
• Customer-Facing Applications: Strong knowledge of customer-facing applications.
• Facets Validation: Validate Facets benefit plans, claims processing, and pre/post adjudication rules.
• Collaboration: Work closely with business analysts and developers to understand business requirements/user stories.
• SQL Proficiency: Proficiency in SQL for data validation.
• Defect Management Tools: Experience with defect management tools like JIRA, Rally, and ADO is a plus.
• Analytical Skills: Strong analytical and problem-solving skills.
• Communication Skills: Excellent verbal and written communication skills.
• Certifications: Health care certifications are an added advantage.