Test Lead II – Healthcare Payer Testing

HealthEdge

. Develop detailed test cases, scenarios, and scripts for claims processing, enrollment, benefits, provider data, and EDI transaction flows .

Posted 10/16/2026full-timeRemote • United StatesSenior💰 $90,000 - $120,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in software QA/testing with a focus on U.S. healthcare payer systems, including claims processing and EDI transactions. Proficient in defect lifecycle management and compliance testing, ensuring adherence to HIPAA and X12 standards.

Highest-signal resume keywords

5+ Years In Software QA/TestingLead Or Senior Tester RoleTesting U.S. Healthcare Payer SystemsProficiency In Defect Tracking ToolsWorking Knowledge Of EDI X12 Transactions

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Test Case DesignBoundary AnalysisEquivalence PartitioningNegative Testing TechniquesDefect Lifecycle ManagementRequirements AnalysisTest ManagementCompliance TestingEDI Transaction ValidationRisk Analysis

Soft Skills

Attention To DetailCollaborationCommunication

Tools & Technologies

JIRAZephyrALM

Industry Keywords

Claims ProcessingEnrollmentBenefitsProvider DataEDI TransactionsHIPAA ComplianceICD UpdatesCMS MandatesMedicaid RulesPayer Business Rules

About the role

Key responsibilities & impact

Develop detailed test cases, scenarios, and scripts for claims processing, enrollment, benefits, provider data, and EDI transaction flows
Lead functional, integration, regression, and UAT cycles for assigned payer modules
Analyze requirements and business rules to identify gaps, ambiguities, and testability issues before execution
Own defect lifecycle management, including logging, triage, root cause classification, retesting, and closure tracking
Validate EDI transactions (834, 837, 835, 270/271, 820) against payer business rules and X12 standards
Support compliance and regulatory test cycles, including ICD updates, CMS mandates, and state-specific Medicaid rules
Coordinate with developers, business analysts, and configuration teams to resolve blockers and clarify expected behavior
Produce daily and weekly execution status reports with defect metrics, coverage status, and risk flags
Manage offshore QA analysts
Collaborate closely with the Test Manager and cross-functional delivery teams

Requirements

What you’ll need

5+ years in software QA/testing
2+ years in a lead or senior tester role
Solid experience testing U.S. healthcare payer systems, including claims, enrollment, benefits, or provider network
Working knowledge of EDI X12 transactions and HIPAA compliance requirements
Hands-on test case design experience using boundary analysis, equivalence partitioning, and negative testing techniques
Proficiency in defect tracking and test management tools such as JIRA, Zephyr, ALM, or equivalent
Ability to read and interpret payer business rules, EOPs, benefit plan documents, and SLAs
Strong attention to detail
Candidates may be required to undergo a pre-employment criminal background check

Benefits

Comp & perks

Remote work arrangement
Working hours aligned to Eastern Standard Time
Up to 5% travel
Reasonable accommodations for individuals with disabilities
Equal opportunity employment
Workforce diversity and inclusion