Must Have Technical/Functional Skills
•Strong SME knowledge in Healthcare Claims Processing lifecycle
•Expertise in EDI formats – 837 (P/I/D), 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 QA/Testing
•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 (837/835/834)
•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
•Familiarity with Agile/Scrum methodologies
•Excellent stakeholder communication and coordination skills
•Experience in risk identification, defect triage, and RCA
Roles & Responsibilities
•Lead end-to-end testing for Claims, Enrollment, and Billing modules
•Act as SME for Claims Processing and EDI transactions
•Validate Facets Claims and Membership workflows
•Design and execute test strategies, test plans, and test cases
•Perform EDI validation (837, 835, 834) including mock data creation
•Manage defect lifecycle, triage, and resolution tracking in ADO
•Ensure HIPAA compliance in all testing activities
•Validate ITS claims processing across SF, DF, RF flows
•Drive quality metrics, reporting, and release sign-offs
•Collaborate with business, development, and partner teams for E2E validation
Generic Managerial Skills, If any
•Leading and Mentoring team members
•Strong problem-solving and critical thinking
•Ability to work with minimal supervision
•Documentation and knowledge sharing
•Excellent communication
Salary Range: $80,000- $120,000 a year
TCS Employee Benefits Summary:
Discretionary Annual Incentive.
Comprehensive Medical Coverage: Medical & Health, Dental & Vision, Disability Planning & Insurance, Pet Insurance Plans.
Family Support: Maternal & Parental Leaves.
Insurance Options: Auto & Home Insurance, Identity Theft Protection.
Convenience & Professional Growth: Commuter Benefits & Certification & amp; Training Reimbursement.
Time Off: Vacation, Time Off, Sick Leave & Holidays.
Legal & Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing.
#LI-DNI
More Information
Application Details
- Organization DetailsTCS / Tata Consultancy Services
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