QA Manager - PBM Claims Processing

QA Manager - PBM Claims Processing

Location : Remote with Travel

Type : Contract

Position Summary

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.

Key Responsibilities

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.

PBM Domain Expertise

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.

Metrics-Based Team Management

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.

Agile Delivery and Test Management

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.

Hands-On Testing and Innovation

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.

Required Qualifications

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.

Preferred Qualifications

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.

Tekshapers is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.