QA Manager

We are seeking an experienced and highly motivated QA Manager to lead quality engineering and testing initiatives for Pharmacy Benefit Management (PBM) platforms. The ideal candidate will bring a strong process orientation, an engineering mindset, hands-on testing depth, and proven experience managing QA teams using measurable quality and delivery metrics.

Quality Engineering Leadership

· Lead and manage QA teams supporting PBM applications and claims processing platforms.

· Establish, standardize, and continuously improve QA processes, methods, templates, and best practices.

· Promote a quality-first culture through process discipline, automation, engineering rigor, and defect prevention.

· Drive root cause analysis, corrective actions, and continuous improvement initiatives to improve product quality.

· Provide subject matter expertise in PBM business processes, with a strong preference for Medicaid claims processing experience.

· Validate end-to-end claims adjudication workflows, including eligibility, formulary, prior authorization, pricing, accumulators, coordination of benefits, reversals, rejects, and payment processing.

· Partner with business, product, compliance, and technology stakeholders to ensure testing aligns with regulatory and business requirements.

· Define, track, and report key quality metrics such as defect density, defect leakage, test coverage, automation coverage, test execution progress, cycle time, and release readiness indicators.

· Use data-driven insights to identify risks, improve productivity, manage capacity, and optimize testing effectiveness.

· Prepare and present quality dashboards, executive status updates, release readiness assessments, and risk summaries.

· Participate actively in Agile ceremonies including sprint planning, backlog refinement, daily standups, retrospectives, and release planning.

· Develop test strategies, test plans, test scenarios, and realistic test effort estimates for projects, releases, and production changes.

· Coordinate testing across multiple initiatives while balancing scope, schedule, risk, and team capacity.

· Collaborate closely with Product Owners, Developers, Business Analysts, Scrum Masters, Release Managers, and Operations teams.

· Remain hands-on when needed across functional, integration, regression, system, UAT support, API, data validation, performance, and automation testing.

· Evaluate and implement modern testing tools, frameworks, and accelerators that improve quality, speed, and repeatability.

· Apply out-of-the-box thinking to solve complex quality challenges and remove delivery bottlenecks.

· 15+ years of software quality assurance experience, including hands-on test design and execution.

· 5+ years of QA leadership or management experience.

· Strong experience supporting PBM claims processing systems.

· Deep understanding of SDLC, Agile execution, test estimation, risk-based testing, and release management.

· Ability to define and manage quality metrics, dashboards, and team performance indicators.

· Strong analytical, communication, stakeholder management, and problem-solving skills.

· Experience with Medicaid PBM programs is strongly preferred.

· Experience with healthcare payer, pharmacy, managed care, or government healthcare systems.

· Knowledge of healthcare compliance, regulatory requirements, audit readiness, and operational controls.

· Experience with test automation frameworks, CI/CD pipelines, API testing tools, SQL, and data validation techniques.

· Experience leading geographically distributed or vendor-partner QA teams.