Technical Lead-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:
• Member eligibility and benefit verification
• Pharmacy/provider validation (NPI, NCPDP ID)
• Real-time POS claims adjudication
• Pricing logic (AWP, MAC, ingredient cost, dispensing fee, copay, accumulators)
• Experience in testing scenarios involving:
• Coordination of Benefits (COB) / Other Payer
• Prior Authorization (PA)
• Formulary and benefit plan rules
• 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