QA Analyst EDIFECS

QA Analyst – EDIFECS

Healthcare EDI & Core Admin Platform

Location: Remote

Experience: 8–10 years

Tech Stack: Edifecs (SpecBuilder, XEngine, Transaction/EDI Gateway, Encounter Management), QA Tools (JIRA, ALM, Postman, SoapUI), MongoDB, PostgreSQL, Oracle, X12 EDI (270/271, 834, 835/837, 275, 276/277), AI-Assisted Testing

Role Overview

We are looking for a detail-oriented and analytically strong Lead QA Analyst with hands-on EDIFECS experience to validate, test, and quality-assure the EDI integration layer of our large healthcare core administration platform. This is an execution-focused, hands-on role: you will design and execute test plans for trading partner configurations, transaction maps, and validation rules; validate HIPAA X12 EDI transaction flows end-to-end; and provide day-to-day QA support for high-volume EDI transaction processing — working under the direction of the onsite Lead EDIFECS Analyst and QA Lead.

Key Responsibilities

·       Design, develop, and execute comprehensive test plans and test cases for EDIFECS trading partner configurations, transaction maps, and validation rules covering X12 transactions (270/271, 834, 835/837, 275, 276/277).

·       Perform functional, regression, integration, and end-to-end testing of EDIFECS configurations and EDI transaction flows across development, UAT, and production-support environments.

·       Validate inbound and outbound EDI transaction processing — including segment-level and element-level compliance against HIPAA X12 implementation guides and payer companion guides.

·       Test and certify trading partner onboarding configurations, including acknowledgment flows (999, 997, TA1, 277CA) and connectivity validation (AS2, SFTP).

·       Identify, document, and track defects using JIRA or equivalent tools; work closely with the EDIFECS development and configuration team to facilitate timely resolution.

·       Collaborate with the onsite lead and client stakeholders on requirements clarification and design validation

·       Validate SpecBuilder specs, maps, and custom validation/business rules against defined requirements and companion guide standards.

·       Perform database validation across MongoDB, PostgreSQL, and Oracle to verify EDI transaction data integrity at the persistence layer.

·       Support production defect triage and troubleshooting — analyzing transaction failures and rejections, identifying root causes, and validating fixes.

·       Create and maintain QA documentation including test plans, test cases, traceability matrices, and defect reports.

·       Collaborate with the onsite lead, EDIFECS configuration team, and client stakeholders on requirements clarification, test scope definition, and sign-off.

·       Participate in configuration and code reviews from a quality and testability perspective.

·       Support broader platform modernization and regression testing initiatives by providing EDI/EDIFECS QA subject matter expertise.

Required Qualifications

·       Bachelor's degree in Computer Science, Engineering, Health Informatics, or a related field.

·       8-10 years of experience in healthcare EDI/integration QA, with strong hands-on experience testing EDIFECS configurations (SpecBuilder, XEngine, Transaction/EDI Gateway).

·       Strong working knowledge of core HIPAA X12 EDI transactions: 270/271, 834, 835/837, 275, and 276/277 — including segment and element-level validation.

·       Demonstrated ability to write detailed test plans, test cases, and traceability matrices for EDI/integration testing.

·       Experience validating trading partner onboarding flows, acknowledgment handling (999/997/TA1/277CA), and connectivity channels (AS2, SFTP).

·       Hands-on experience with defect management and test management tools (JIRA, HP ALM, or equivalent).

·       Ability to query and validate data in MongoDB, PostgreSQL, and Oracle databases to verify backend EDI transaction integrity.

·       Experience with API/EDI testing tools such as Postman, SoapUI, or similar for validating transaction payloads.

·       Strong analytical and debugging skills for diagnosing EDI transaction failures and rejections in high-volume production environments.

·       Good written and verbal communication skills for collaborating with onsite leads, developers, and client stakeholders.

AI Knowledge & AI-Assisted Testing (Required)

·       Daily, practical use of AI coding/assistant tools to accelerate EDIFECS test case generation, test data creation, and defect analysis.

·       Able to critically review and validate AI-generated test cases, assertions, and configurations for correctness before execution.

·       Understanding of secure and compliant AI tool usage, including never entering PHI, member data, or other sensitive information into prompts or external AI tools.

·       Able to identify where AI-driven automation can improve day-to-day EDI testing, regression coverage, or defect triage efficiency.

Preferred Qualifications

·       Experience with health plan/payer core administration systems (e.g., Facets, QNXT, HealthRules) from a QA/testing perspective.

·       Familiarity with CAQH CORE operating rules and their testing implications.

·       Exposure to automated testing frameworks applicable to EDI/integration testing pipelines.

·       Experience with mainframe or cloud-based integration patterns supporting EDI processing.

·       Relevant certifications: EDIFECS product certifications, ISTQB, or equivalent QA certifications.