Facets Tester (Healthcare Claims QA Analyst) - USA Remote
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Please review the Job Description (JD) below and share the best suited profiles.
Job Title: Facets Tester (Healthcare Claims QA Analyst)
Location:
USA Remote
Duration: 5 Months Contract
Position Summary
We are seeking experienced Facets Testers / Healthcare Claims QA Analysts with strong expertise in Facets data model, SQL-based claims validation, and Medicare claims processing.
This role is responsible for defining and executing end-to-end testing for healthcare claims workflows, validating claim outcomes, performing aggregate data analysis, comparing results with legacy systems, and documenting discrepancies across enterprise claims platforms.
The ideal candidate must possess deep hands-on experience with Facets claim adjudication, Facets backend tables, SQL querying, defect tracking, and Medicare claims business rules.
Key Responsibilities
- Analyze business and functional requirements and create detailed test cases/scenarios in Jira.
- Execute manual and backend validation test cases across Facets healthcare claims modules.
- Document test execution results, evidence, and issue summaries.
- Perform re-testing, regression testing, and defect validation after fixes.
- Create and run complex SQL queries for aggregate data validation, backend reconciliation, and claims analysis.
- Validate claims processing outcomes across:
- member eligibility,
- provider setup,
- benefit plans,
- pricing,
- accumulators,
- edits,
- adjudication,
- payment.
- Research and analyze parallel testing mismatches by comparing Facets results with legacy claims processing systems.
- Investigate root cause of discrepancies in:
- claim status,
- pricing variances,
- denial reasons,
- payment differences,
- benefit application.
- Log defects with complete supporting documentation and collaborate with development/configuration teams.
- Maintain traceability between requirements, test cases, execution, and defects.
- Support UAT, SIT, regression, and production validation efforts.
Required Skills / Must Have
- Strong hands-on experience as a Facets Tester / Facets QA Analyst / Healthcare Claims Tester.
- Deep understanding of Facets Data Model including backend claims-related tables.
- Extensive SQL querying experience for healthcare claims validation and aggregate analysis.
- Strong end-to-end knowledge of Facets Claim Processing Life Cycle, including:
- claim intake,
- editing,
- pricing,
- adjudication,
- payment,
- explanation of benefits.
- Proven Medicare Claims processing/testing experience.
- Experience creating and executing:
- manual test cases,
- backend validation scripts,
- defect retesting,
- regression suites.
- Strong defect management and test documentation skills.
- Ability to compare current Facets outcomes against legacy claims systems and identify discrepancies.
- Strong analytical and troubleshooting skills.
- Candidate must meet minimum 3 years US Residential Requirement.