Edifecs QA Analyst

Job Purpose Ensure the accuracy, compliance and reliability of healthcare claims processing. Job Description Analyzing claims requirements, HIPAA implementation guides and payer companion guides to identify test scenarios and achieve good test coverage. Creating and maintaining test cases and EDI test files covering positive, negative and edge-case claim scenarios. Executing claims files through Edifecs and validating results against HIPAA SNIP levels and payer-specific rules. Validating acknowledgments and responses for accuracy and correct error reporting. Performing end-to-end testing from EDI intake through the claims processing system, including data mapping and adjudication validation using SQL. Duties and Responsibilities Define and document the claims EDI test strategy, covering validation, end-to-end and regression testing. Create and maintain EDI test files for positive, negative and edge-case claim scenarios. Configure and maintain the test environment, including Edifecs setup, test data and trading partner configurations. Execute claims files through Edifecs as planned and as needed, and validate results against SNIP levels and payer-specific rules. Validate acknowledgments and responses and verify claim data in downstream claims systems using SQL. Report defects and track them to closure. Maintain the regression suite and test data to keep them consistent and reliable across code set updates and system changes. Specifics The candidate should have excellent communication skills, strong interpersonal skills and be team oriented Innovative in proposing/implementing new ideas/processes Highly motivated and self-starting, should have a proactive approach to resolving issues and working with limited supervision Ability to quickly learn new testing tools/technology and implement it effectively To Adhere to ISMS policies and procedures