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EDI Expertise: Develop test cases/scenarios for Facets and EDI-X12 transactions (837, 834, 835, 270, 271, 277). Validate X12 segment and looping structure against healthcare standards, including HIPAA and SNIP level validations.
Health Insurance Knowledge: Strong understanding of health insurance processes like claims and enrollment.
Customer-Facing Applications: Strong knowledge of customer-facing applications.
Facets Validation: Validate Facets benefit plans, claims processing, and pre/post adjudication rules.
Collaboration: Work closely with business analysts and developers to understand business requirements/user stories.
SQL Proficiency: Proficiency in SQL for data validation.
Defect Management Tools: Experience with defect management tools like JIRA, Rally, and ADO is a plus.
Analytical Skills: Strong analytical and problem-solving skills.
Communication Skills: Excellent verbal and written communication skills.
Certifications: Healthcare certifications are an added advantage.