Must Have Technical/Functional Skills
• Strong SME knowledge in Healthcare Claims Processing lifecycle
• Expertise in EDI formats 837 (P/I/D), 835, 834
• Hands-on experience in Facets (Claims + Enrollment modules)
• Proficiency in Azure DevOps (ADO) for QA tracking
• Knowledge of HIPAA compliance and payer systems
• 8+ years of experience in Healthcare QA/Testing
• 4+ years of experience as Test Lead in Facets projects
• Deep understanding of Claims Adjudication & Payment workflows
• Experience in handling claims denials, adjustments, and reprocessing
• Strong exposure to EDI claim and remittance transactions
• Experience in mocking and validating EDI files (837/835/834)
• Knowledge of ITS claims processing (SF, DF, RF)
• Experience in Member Enrollment workflows (Medicaid, Medicare, ACA)
• Understanding of Billing lifecycle for member enrollment
• Hands-on experience with ADO Test Plans, Test Suites, and Defect tracking
• Ability to perform data validation and reconciliation activities
• Strong experience in functional and end-to-end testing
• Familiarity with Agile/Scrum methodologies
• Excellent stakeholder communication and coordination skills
• Experience in risk identification, defect triage, and RCA
Roles & Responsibilities
• Lead end-to-end testing for Claims, Enrollment, and Billing modules
• Act as SME for Claims Processing and EDI transactions
• Validate Facets Claims and Membership workflows
• Design and execute test strategies, test plans, and test cases
• Perform EDI validation (837, 835, 834) including mock data creation
• Manage defect lifecycle, triage, and resolution tracking in ADO
• Ensure HIPAA compliance in all testing activities
• Validate ITS claims processing across SF, DF, RF flows
• Drive quality metrics, reporting, and release sign-offs
• Collaborate with business, development, and partner teams for E2E validation
Generic Managerial Skills, If any
• Leading and Mentoring team members
• Strong problem-solving and critical thinking
• Ability to work with minimal supervision
• Documentation and knowledge sharing
• Excellent communication
Salary Range: $80,000- $100,000 a year
TCS Employee Benefits Summary:
Discretionary Annual Incentive.
Comprehensive Medical Coverage: Medical & Health, Dental & Vision, Disability Planning & Insurance, Pet Insurance Plans.
Family Support: Maternal & Parental Leaves.
Insurance Options: Auto & Home Insurance, Identity Theft Protection.
Convenience & Professional Growth: Commuter Benefits & Certification & amp; Training Reimbursement.
Time Off: Vacation, Time Off, Sick Leave & Holidays.
Legal & Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing.
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