Healthcare Quality Assurance Automation Lead

Job Title: Healthcare Quality Assurance Automation Lead

Location: Remote

Duration: Fulltime

 Job Description :

 Key Points:

1.         We need a hands-on QA Lead with a consulting background.

2.         Healthcare experience should be strong.

3.         TOSCA experience is a must

 Healthcare payer domain skills

• Lines of business. Medicaid, Medicare Advantage, Duals/MMP, TRICARE, and Marketplace — each with its own eligibility, submission, and reconciliation rules. Medicaid depth matters most for this client.
• Facets. The core administration platform. Module-level testing experience in claims, membership/enrolment, or provider/network configuration is the strongest signal we can source for; validating Facets-sourced data through APIs or middleware is the acceptable lighter form.
• X12 EDI fluency. The transaction sets that run a payer: 834 enrolment (adds, changes, terms, retro adjustments, dual enrolment), 837P/I/D claims and encounters, 277CA/999/TA1 acknowledgements, 835 remittance, 278 prior authorization, 270/271 eligibility, 820 premium payment. Candidates should read loops and segments unaided and know what a companion guide is. Edifecs or similar validation tooling is a plus.
• Regulatory context. Encounter submissions to CMS and state Medicaid agencies, CMS interoperability mandates (Patient Access and Provider Directory APIs, FHIR R4/HL7), directory-accuracy requirements, HIPAA data handling, and audit-grade traceability for financial flows.
• Payer operations literacy. Provider data (NPI, TIN, taxonomy, credentialing, network status), enrolment reconciliation against downstream eligibility and claims, prior-authorization lifecycles (pend, approve, deny, appeal), premium billing, capitation, claims-to-GL reconciliation, and MLR reporting. Adjacent platform exposure — member/provider portals, CRM/IVR contact-centre flows, OnBase or comparable document management — rounds out the profile.

 Quality engineering skills

• Test design over test execution. People who derive scenarios from business rules and companion guides, design reconciliations (source file vs. system of record vs. downstream), and run defect triage through to root cause — across SIT, UAT, regression, and go-live.
• SQL, unaided. Every role validates data across systems; candidates must write their own multi-table queries.
• API and integration testing. REST and SOAP with Postman, Rest Assured, or SoapUI; schema and contract validation; message-flow testing through ESB/middleware layers (routing, transformation, error handling).
• UI automation. Selenium or Playwright built by the candidate, with cross-browser/device coverage and authentication scenarios (SSO, MFA, role-based access). WCAG accessibility awareness is a plus.
• Enterprise automation toolchain. TOSCA (through distributed execution at the senior end) and Robot Framework; Azure DevOps for test management, defects, and CI/CD pipelines; qTest exposure helps. Python or Java for utilities and parsing libraries distinguishes the top tier.
• AI-assisted testing. Working comfort with LLM-assisted test generation, data synthesis, and defect triage (Copilot, Azure OpenAI, Claude) under human review. Probe for real artifacts; certificates alone don’t count.
• Delivery discipline. Agile/Scrum ceremonies, sprint-level accountability, and clean defect hygiene in ADO. Offshore candidates must sustain roughly four hours of daily IST↔US-Eastern overlap; client-facing candidates must hold their own with business stakeholders in UAT and QBR settings.