Senior PBM Pharmacy Claims QA Test Engineer - Remote / Telecommute

The organization is looking for a Test Engineer with strong pharmacy claims and PBM testing experience to support an NCPDP D.0 to F6 implementation. This role is responsible for validating transaction changes, claim adjudication outcomes, eligibility and coordination of benefits scenarios, reject messaging, payer sheet impacts, data mapping, regression coverage, and production readiness. The successful candidate has strong pharmacy claims testing experience, working knowledge of NCPDP D.0, the ability to learn and validate F6 changes, strong SQL and data validation skills, and experience collaborating with PBM Subject Matter Experts, Business Analysts, development, and business teams. Key experience includes NCPDP D.0, NCPDP F6, PBM/pharmacy claims, SQL, SIT, UAT, Parallel, regression testing, trading partner testing, release testing, production validation, and post-implementation defect triage. Primary Skills:

• PBM - Pharmacy Benefits Manager Domain knowledge is Mandatory.
• Pharmacy Claims & PBM Domain Testing.
• NCPDP D.0 / F6 Standards & Migration Validation.
• Claim Adjudication, Eligibility, COB, Pricing & Reject Messaging.
• Test Planning, Test Cases, Test Scripts, Traceability & Test Data.
• Functional, SIT, UAT, Regression, Integration, E2E, Parallel, Release & Production Validation.
• SQL, Backend Data Validation, Reconciliation & Claims Data Analysis.
• Payer Sheet, Field Mapping, Business Rules & Transaction Specification Analysis.
• Defect Management, Retesting, QA Reporting & Release Readiness.
• SDLC, Agile/Scrum/Waterfall & Cross-functional Collaboration.
• AI Tools for Test Automation., * Analyze NCPDP D.0 and F6 implementation requirements, payer sheets, field mapping documents, business rules, and transaction specifications to identify test scenarios and validation needs.
• Create and maintain test plans, test scenarios, test cases, test scripts, test data, and traceability for pharmacy claim transaction testing.
• Analyze requirements and coordinate with Business Analysts and Subject Matter Experts.
• Validate NCPDP pharmacy claim request and response transactions, including claim submission, reversal, eligibility, coordination of benefits, reject codes, messaging, pricing, accumulators, and coverage determination scenarios.
• Perform functional, regression, integration, end-to-end, batch, database, API/interface, UAT support, Parallel and production validation testing for D.0 to F6 changes.
• Develop and execute SQL queries to validate claims data, member eligibility, benefit setup, pricing, accumulators, drug data, payer configuration, and downstream reporting impacts.
• Compare D.0 and F6 transaction behavior to confirm that new, modified, and retired fields are processed correctly across impacted systems.
• Identify, document, track, retest, and close defects using approved defect management processes and tools.
• Support test data creation for positive and negative scenarios.
• Coordinate testing dependencies with PBM Subject Matter Experts, business users, developers, PBM teams, and downstream application teams.
• Coordinate Onshore / Offshore activities as needed.
• Utilize working knowledge of AI tools for automation.
• Prepare daily or weekly status updates, defect reports, test execution metrics, test coverage summaries, and implementation risk updates.
• Participate in requirement reviews, design walkthroughs, payer sheet reviews, field mapping reviews, release readiness meetings, and implementation checkpoints., Job Title: Java Engineer Location: Whippany, NJ (2 days Onsite) Duration: Contract Job Description: Hands on with Spring Boot 3, Spring, Java 31, Mongo, REST, Event based appl…
• 2 months ago
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• Minimum of 7 years of Quality Assurance or software testing experience, preferably in healthcare, PBM or pharmacy claims environments.
• Hands-on experience testing pharmacy claims, claim adjudication, eligibility, benefits, pricing, accumulators, reject codes, and claim response messaging.
• Working knowledge of NCPDP Telecommunication Standard Version D.0; exposure to Version F6 implementation or standards migration is strongly preferred.

Platinum Global Talent Solutions Ltd.

• Newark, NJ

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