- Job Role: Total Quality Management -Claims Management
- Experience (In Years): 6-9
We are seeking a detail-oriented ACAS Tester with experience in US Healthcare Claims Adjudication, Claims Testing, and Payment Integrity Validation. The candidate will be responsible for validating claim processing outcomes, testing business rules, analyzing claim adjudication results, and ensuring compliance with healthcare policies and client requirements.
Responsibilities
- Perform end-to-end testing of healthcare claims processed through the ACAS platform.
- Validate claim adjudication outcomes, pricing logic, payment calculations, and benefit application.
- Execute test cases for overpayment recovery, refund processing, and claims rework workflows.
- Validate payment integrity edits and ensure accurate implementation of business requirements.
- Analyze test results, identify defects, document findings, and coordinate with development teams for resolution.
- Perform regression, integration, system, and user acceptance testing (UAT).
- Review claims data and validate member, provider, and claim attributes.
- Support release validation, production verification, and post-implementation testing activities.
- Collaborate with business stakeholders to understand requirements and create comprehensive test scenarios.
- Prepare test plans, test cases, traceability matrices, and test execution reports.
Qualifications
- Bachelor's Degree in Computer Science, Information Technology, Healthcare Management, or related field.
Relevant experience in US Healthcare Claims Testing and ACAS platform validation
