Job Summary
The QA Manager - PBM Claims Processing will lead quality assurance strategy, testing execution, and continuous improvement initiatives for Pharmacy Benefit Management (PBM) claims processing systems. The role requires extensive QA experience, proven leadership and team management capabilities, and strong knowledge of end-to-end claims adjudication. The QA Manager will oversee test planning, Agile delivery, quality metrics, defect tracking, test coverage, automation performance, and release readiness while maintaining hands-on involvement in technical testing, API validation, SQL, and test automation.
Key Responsibilities
• Lead QA strategy, planning, execution, and continuous improvement initiatives for PBM claims processing systems.
• Manage and guide QA teams while driving quality initiatives and ensuring effective testing practices.
• Oversee end-to-end testing of PBM claims processing and claims adjudication workflows.
• Develop and maintain test plans, test scenarios, and test cases aligned with business and technical requirements.
• Monitor and report QA metrics, including defect tracking, test coverage, automation metrics, dashboards, and release readiness.
• Drive process improvements and promote quality standards across Agile delivery teams.
• Perform and oversee hands-on technical testing, including API testing, SQL-based validation, data validation, and test automation.
• Identify, track, and resolve quality risks and defects throughout the software development lifecycle.
• Collaborate with cross-functional teams to support release decisions and ensure delivery quality.
Required Qualifications
• 15+ years of QA experience, including hands-on testing and test execution.
• 5+ years of QA leadership or management experience, leading teams and driving quality initiatives.
• Strong Pharmacy Benefit Management (PBM) claims processing experience, including understanding of end-to-end claims adjudication.
• Experience developing QA strategies, improving processes, planning tests, and supporting Agile delivery.
• Experience with metrics-driven QA management, including defect tracking, test coverage, automation metrics, dashboards, and release readiness.
• Hands-on technical testing experience, including API testing, SQL, data validation, and test automation.
Preferred Qualifications
• Medicaid PBM experience.
