Functional Lead Cincinnati - OH - Ohio

Must Have TechnicalFunctional Skills

Strong SME knowledge in Healthcare Claims Processing lifecycle

Expertise in EDI formats 837 (PID), 835, 834

Hands-on experience in Facets (Claims + Enrollment modules)

Proficiency in Azure DevOps (ADO) for QA tracking

Knowledge of HIPAA compliance and payer systems

8+ years of experience in Healthcare QATesting

4+ years of experience as Test Lead in Facets projects

Deep understanding of Claims Adjudication & Payment workflows

Experience in handling claims denials, adjustments, and reprocessing

Strong exposure to EDI claim and remittance transactions

Experience in mocking and validating EDI files (837835834)

Knowledge of ITS claims processing (SF, DF, RF)

Experience in Member Enrollment workflows (Medicaid, Medicare, ACA)

Understanding of Billing lifecycle for member enrollment

Hands-on experience with ADO Test Plans, Test Suites, and Defect tracking

Ability to perform data validation and reconciliation activities

Strong experience in functional and end-to-end testing