Manual QA Engineer - PBM

job summary:

We are seeking an experienced Manual QA Engineer to join our quality assurance team. This role is responsible for validating claims adjudication logic, benefit configurations, and system behavior across our PBM platform to ensure accuracy, compliance, and reliability before releases reach production.

location: Telecommute
job type: Permanent
salary: $80,000 - 110,000 per year
work hours: 8am to 5pm
education: Bachelors
responsibilities:

Key Responsibilities

• Design, write, and execute manual test cases and test plans covering claims adjudication, pricing, formulary, accumulators, prior authorization, and benefit plan configuration
• Validate claim outcomes (paid, rejected, reversed) against expected adjudication logic and plan setup
• Perform regression, functional, and end-to-end testing across releases and configuration changes
• Identify, document, and track defects with clear reproduction steps, expected vs. actual behavior, and business impact
• Collaborate with business analysts, developers, and configuration teams to clarify requirements and validate fixes
• Test edge cases involving copay structures, DUR, accumulator resets, coordination of benefits, and vendor integrations
• Maintain and update test documentation, test data sets, and traceability to requirements
• Participate in Stage cycles and support release sign-off decisions

qualifications:

Required Qualifications

3-5 years of manual QA testing experience within a PBM, health plan, or pharmacy claims environment

Hands-on experience testing claims adjudication systems and pharmacy benefit configurations

Working knowledge of pharmacy claims concepts: NCPDP claim formats, formulary/tiering, copay/coinsurance logic, accumulators, DUR, prior authorization, and rebates

Strong ability to write clear, structured test cases and defect reports

Experience with test case management and defect tracking tools (e.g., Azure DevOps, Jira, TestRail, or similar)

Solid understanding of the software QA lifecycle (test planning, execution, regression, UAT)

Excellent attention to detail and ability to spot discrepancies in complex rule-based systems

Strong written and verbal communication skills for cross-functional collaboration

Preferred Qualifications

Familiarity with SQL for querying claims and configuration data to validate test results

Experience testing across multiple PBM platforms or claims switch vendors

Understanding of HIPAA and PHI handling requirements in a testing environment

Exposure to Agile/Scrum development processes

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad Digital, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad Digital offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.