Experience Required:
- Minimum of 4-6 years QA experience with PBM / pharmacy claims domain knowledge
- Experience in writing SQL queries for data validation
- Ability to design and execute test cases, test scenarios, and test data
- Hands-on experience in validating end-to-end pharmacy claims lifecycle, including:
oMember eligibility and benefit verification
oPharmacy/provider validation (NPI, NCPDP ID)
oReal-time POS claims adjudication
oPricing logic (AWP, MAC, ingredient cost, dispensing fee, copay, accumulators)
- Experience in testing scenarios involving:
oCoordination of Benefits (COB) / Other Payer
oPrior Authorization (PA)
oFormulary and benefit plan rules
oSpecialty and retail pharmacy claims
- Understanding of NCPDP standards (D.0; exposure to F6 preferred)
- Ability to interpret business and technical requirements for testing Agile/Waterfall models
- Good communication skills to report test results and defects clearly
- Experience in web services/API testing using Postman or SoapUI
- Basic knowledge of automation tools and testing practices
- Strong interpersonal skills and ability to work with cross-functional teams
