We are seeking an experienced RxCLAIM QA Lead to lead quality assurance activities for pharmacy benefits management (PBM) systems, with a strong focus on RxCLAIM. The ideal candidate will combine deep domain expertise in pharmacy claims with hands-on QA leadership, ensuring high-quality delivery across complex healthcare platforms.
Key Responsibilities
- Lead end-to-end QA activities for RxCLAIM-based applications, including test strategy, planning, execution, and defect management
- Act as the QA point of contact for PBM/RxCLAIM initiatives, collaborating closely with business analysts, developers, and product owners
- Define and enforce QA processes, standards, and best practices across projects
- Review and validate business requirements, functional specifications, and technical designs from a QA perspective
- Design and oversee test scenarios, test cases, and test data covering eligibility, claims adjudication, pricing, formularies, benefits, accumulators, and prior authorization
- Lead and mentor QA analysts, providing guidance on RxCLAIM workflows and testing techniques
- Coordinate SIT, UAT, and regression testing, including support for business and client UAT cycles
- Ensure compliance with healthcare regulations and industry standards (HIPAA, CMS, etc.)
- Track test execution metrics, defect trends, and quality KPIs; report status to stakeholders
- Support automation initiatives by identifying regression candidates and working with automation teams
- Participate in release planning, production validation, and post-release defect analysis