Luxoft
Posted 6 days agoVerified live 2d ago
Healthcare Claims Tester
Brief overview
Remote
UndergradOr in progress
4+ yrsMinimum
Healthcare Claims ProcessingHealthRules Payer (HRP)Claims TestingEDI 837Blue Card Claims ProcessingHealthcare Claims Lifecycle and AdjudicationBenefits and Package Pricing ConfigurationHealthcare Medical Coding CPTHealthcare Medical Coding HCPCSHealthcare Medical Coding ICD-9/ICD-10Healthcare Medical Coding CDTHealthcare Medical Coding RevenueHealthcare Medical Coding DRGAzure DevOpsSQLThird-Party Administrator (TPA) IntegrationsAgile Methodology
About the company
Luxoftluxoft.com
Luxoft is an IT company that works globally to give customers software development, product engineering, and consulting. It is a sub-organization of DXC Technology.
Job description
Summary
Luxoft is hiring a Healthcare Claims Tester to support testing for a non-profit healthcare organization in the United States. The role focuses on validating healthcare claims processing, benefits, pricing, EDI transactions, Blue Card claims, and HRP-to-TPA workflows within HealthRules Payer, while collaborating with business and technical teams.
Responsibilities
- Perform functional and end-to-end testing of healthcare claims processing within HealthRules Payer (HRP)
- Validate local claims processing workflows, business rules, benefits, pricing, and claims adjudication
- Test and validate EDI 837 files and associated claims-processing workflows
- Perform testing for Blue Card claims and related business scenarios
- Validate HRP-to-TPA workflows, including upstream and downstream claims transactions
- Create and execute test cases and test scenarios based on business and functional requirements
- Analyze claims-processing results and identify inaccuracies or inconsistencies in business rules, configurations, pricing, and claim payments
- Document, track, retest, and support resolution of defects identified during testing
- Support investigation and resolution of production issues related to claims, benefits, and pricing configurations
- Participate in business requirements and solution-review sessions to identify testing requirements and potential gaps
- Collaborate with business and IT teams to validate system changes, enhancements, and configuration updates before production deployment
- Provide subject-matter expertise regarding healthcare claims processing and HRP workflows
- Maintain appropriate testing and system documentation
Skills
- 4+ years of experience in healthcare claims processing, healthcare operations, or claims testing
- Strong hands-on knowledge of local claims processing within HealthRules Payer (HRP)
- Hands-on experience working with and validating EDI 837 files
- Experience with Blue Card claims processing and/or strong understanding of HRP-to-TPA workflows
- Strong understanding of healthcare claims lifecycle, adjudication, benefits, pricing, and payment workflows
- Good knowledge of healthcare and health-plan terminology
- Understanding of relevant medical and industry-standard codes, including CPT, HCPCS, ICD-9/ICD-10, CDT, Revenue, and DRG codes
- Experience creating and executing functional, integration, and end-to-end claims test scenarios
- Ability to analyze claims-processing results, identify defects and configuration issues, and work with technical and business teams through resolution
- Experience working with business requirements and translating them into comprehensive test scenarios
- Working knowledge of Azure DevOps or similar test/defect management tools
- Strong communication skills and ability to collaborate with business and technical stakeholders
- Experience with BCBS Association requirements and Blue Card mandates
- Experience with benefits and package pricing configuration in HealthRules
- SQL knowledge for data validation and claims analysis
- Experience troubleshooting production issues related to claims or benefit configurations
- Previous experience supporting healthcare system migrations, integrations, or major HRP enhancements
- Experience working with Third-Party Administrator (TPA) integrations and workflows
- Bachelor's degree in Business Administration, Management Information Systems, Computer Science, or a related field, or equivalent relevant professional experience
- Experience in Agile methodology and framework
Qualifications
Must Haves
- 4+ years of experience in healthcare claims processing, healthcare operations, or claims testing
- Strong hands-on knowledge of local claims processing within HealthRules Payer (HRP)
- Hands-on experience working with and validating EDI 837 files
- Experience with Blue Card claims processing and/or strong understanding of HRP-to-TPA workflows
- Strong understanding of healthcare claims lifecycle, adjudication, benefits, pricing, and payment workflows
- Good knowledge of healthcare and health-plan terminology
- Understanding of relevant medical and industry-standard codes, including CPT, HCPCS, ICD-9/ICD-10, CDT, Revenue, and DRG codes
- Experience creating and executing functional, integration, and end-to-end claims test scenarios
- Ability to analyze claims-processing results, identify defects and configuration issues, and work with technical and business teams through resolution
- Experience working with business requirements and translating them into comprehensive test scenarios
- Working knowledge of Azure DevOps or similar test/defect management tools
- Strong communication skills and ability to collaborate with business and technical stakeholders
- Experience with BCBS Association requirements and Blue Card mandates
- Experience with benefits and package pricing configuration in HealthRules
- SQL knowledge for data validation and claims analysis
- Experience troubleshooting production issues related to claims or benefit configurations
- Previous experience supporting healthcare system migrations, integrations, or major HRP enhancements
- Experience working with Third-Party Administrator (TPA) integrations and workflows
- Bachelor's degree in Business Administration, Management Information Systems, Computer Science, or a related field, or equivalent relevant professional experience
Nice to Haves
- Experience in Agile methodology and framework
Benefits
- Remote work in the United States
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