QA Lead - PBM

QA Lead - PBM

Posted Today by Kollasoft Inc.

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Negotiable
Undetermined
Remote
Remote
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Application Lifecycle Management Automation Business Requirements Content Management Systems Defect Tracking Device Tracking Software JIRA Management Management Systems Market Trend qTest Regression Testing Stakeholder Management Test Automation Test Data Test Execution Engine Test Management Test Strategy User Acceptance Testing (UAT) Verification And Validation Workflows

Summary: The role of RxCLAIM QA Lead involves leading quality assurance activities specifically for pharmacy benefits management systems, with a focus on RxCLAIM. The candidate will leverage their expertise in pharmacy claims and QA leadership to ensure high-quality delivery across healthcare platforms. This position requires collaboration with various stakeholders and the enforcement of QA processes and standards. The ideal candidate will also mentor QA analysts and support automation initiatives.

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

Key Skills:

  • 8+ years of experience in QA/testing, with at least 3-4 years in a QA Lead role
  • Strong hands-on experience with RxCLAIM (claims processing, plan setup, pricing, benefits, accumulators, DUR, PA)
  • Solid understanding of PBM and pharmacy domain concepts
  • Strong knowledge of test management and defect tracking tools (e.g., ALM, Jira, Zephyr, qTest)
  • Excellent analytical, problem-solving, and communication skills
  • Proven experience leading teams and coordinating with cross-functional stakeholders

Salary (Rate): undetermined

City: undetermined

Country: undetermined

Working Arrangements: remote

IR35 Status: undetermined

Seniority Level: undetermined

Industry: IT

Detailed Description From Employer:
Job Description
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
Qualifications
  • 8+ years of experience in QA/testing, with at least 3 4 years in a QA Lead role
  • Strong hands-on experience with RxCLAIM (claims processing, plan setup, pricing, benefits, accumulators, DUR, PA)
  • Solid understanding of PBM and pharmacy domain concepts
  • Strong knowledge of test management and defect tracking tools (e.g., ALM, Jira, Zephyr, qTest)
  • Excellent analytical, problem-solving, and communication skills
  • Proven experience leading teams and coordinating with cross-functional stakeholders
Preferred Qualifications
  • Experience with test automation tools and frameworks
  • Exposure to other PBM platforms (e.g., QNXT, Facets, ICD)
  • Experience working in Agile/Scrum environments
  • ISTQB or similar QA certification
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