Manual QA Analyst - Healthcare Pharmacy Claims

Area(s) of responsibility

QA Analyst Job Description

Location - Hyderabad/Bengaluru
Mode -Hybrid 3 days in a week
Total Experience - 4-6Years

Domain- Health care Domain is Mandatory

Role Overview
•QA Analyst role supporting Conduent PBM platform for migration from D.0 to F6 standards. 
•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 4-6 years 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: 
oMember eligibility and benefit verification 
oPharmacy/provider validation (NPI, NCPDP ID) 
oReal-time POS claims adjudication 
oPricing logic (AWP, MAC, ingredient cost, dispensing fee, copay, accumulators) 
•Experience in testing scenarios involving: 
oCoordination of Benefits (COB) / Other Payer 
oPrior Authorization (PA) 
oFormulary and benefit plan rules 
oSpecialty 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