QA/Facets Analyst

Role Summary
Seeking a Senior QA Engineer with strong Medicaid payer and Facets expertise to independently validate state-specific regulatory implementations across Facets, Mainframe, Java, DataStage, Talend/TalendWorks, and associated applications.
Key Responsibilities
• Analyze Medicaid regulatory requirements and develop comprehensive test scenarios for individual states.
• Validate end-to-end changes across: 
o Facets
o Mainframe
o Java applications
o DataStage
o Talend/TalendWorks
o APIs/interfaces
o Batch systems
o Upstream/downstream applications
• Test regulatory changes involving member enrollment, eligibility, benefits, claims adjudication, pricing, edits, and payments.
• Validate Mainframe and Java batch/interface processing.
• Perform ETL and source-to-target data validation.
• Conduct functional, integration, end-to-end, regression, negative, and boundary testing.
• Perform independent quality assessments of regulatory solutions.
• Identify gaps between regulatory requirements, requirements documentation, technical implementation, and actual system behavior.
• Perform SQL-based data validation and reconciliation.
• Conduct defect analysis and support root-cause investigation.
• Ensure traceability across Regulation → Business Requirement → System Change → Test Scenario → Test Result.
 

Required Experience
• Strong healthcare payer QA/testing experience.
• Strong testing knowledge of TriZetto Facets.
• Testing experience across Mainframe and Java-based applications.
• Experience validating DataStage and Talend/TalendWorks processes.
• SQL and database testing skills.
• Strong Medicaid managed-care knowledge.
• Experience with state-specific Medicaid requirements.
• Good Medicare and Medicaid health-plan knowledge.
• Strong understanding of: 
o Member enrollment
o Eligibility
o Benefits
o Claims
o Claims adjudication
o Pricing
o Payment
• Experience performing quality assessments for complex regulatory implementations.