Quality Assurance Analyst

This Quality Assurance Analyst will be responsible for reviewing the Claims Processing Systems for configured benefits and reimbursement methodologies. Experienced candidates must demonstrate working understanding of claims processing systems and working knowledge of the health care industry.

Scope of Role & Responsibilities

Create Test Scenarios and Test Cases based on requirements

QA Benefit and Provider Contract Configuration changes in claim systems to meet requirements and business needs

Create UB04 and CMS 1500 test claims aligning to requirements

Meet with business areas to gather business rules and requirements

Meet with Core configuration team to resolve defects

Create and maintain documents related to QA

Analyze QA processes and recommend improvements

Run QA Automation processes

Perform other QA tasks as needed

Required Education, Training & Professional Experience

A Baccalaureate Degree from an accredited college or university; and

Three (3) years of progressive, responsible experience in QA involving test scenario and test case creation; and

Working knowledge of claims both UB04 and CMS1500; and

Working knowledge and expertise in IT applications and systems analysis methodology; and

Working knowledge of Managed Health Care MIS Systems; and

Working knowledge of QA automation tools; or

A satisfactory equivalent combination of training, education, and experience

Professional Competencies

Integrity and Trust

Customer Focus

Functional/Technical skills

Excellent verbal and written communication skills.

Excellent analytical ability.

Excellent interpersonal, customer service and time management skills.

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