QA Manual- Pharmacy Claims

Work Location - Initially Remote, Later hybrid for Coimbatore

We are looking for a QA Engineer with strong experience in US Healthcare applications, preferably with exposure to Pharmacy, PBM, Prescription Claims, Drug Management, or Healthcare Claims processing.

Prior 340B experience is preferred but not mandatory.

The candidate should have strong healthcare domain fundamentals and should be capable of quickly understanding and testing 340B workflows.

Experience

• 4+ years of QA / Software Testing experience

• 2+ years of experience working on US Healthcare applications

• Experience in Pharmacy, PBM, Healthcare Claims, Prescription Claims, Medicaid/Medicare, or similar healthcare products preferred

Key Domain Skills

Candidates with experience in any of the following areas are preferred

• Pharmacy Benefit Management (PBM)

• Pharmacy / Prescription Claims

• Healthcare Claims Processing

• Claim Adjudication

• Medicaid / Medicare

• Drug / NDC Management

• Patient Eligibility

• Provider / Pharmacy Management

• Claim Reversal / Reprocessing

• Financial Reconciliation

• Healthcare Billing

• Contract Pharmacy workflows

• Drug purchase, dispense, and replenishment workflows

Testing Skills

• Strong Functional and Regression Testing experience

• End-to-end healthcare workflow validation

• API Testing using Postman or similar tools

• Strong SQL and database validation

• Backend data validation

• Batch / file processing validation

• Data reconciliation testing

• Integration testing across multiple systems

• Ability to validate large-volume healthcare transaction data

• Good understanding of defect analysis and root-cause investigation

Technical Knowledge

Good understanding of

• REST APIs

• JSON

• SQL

• Database queries

• Healthcare integrations

• EDI / batch files

• Data mapping and transformation

• Authentication and authorization

• HIPAA / PHI handling

Exposure to healthcare standards such as HL7, FHIR, X12, or NCPDP is an added advantage.

340B Knowledge – Preferred, Not Mandatory

Experience or understanding of any of the following will be an added advantage

• 340B Drug Pricing Program

• Covered Entities

• Contract Pharmacies

• Third-Party Administrators (TPA)

• 340B Eligibility

• Claim qualification

• Accumulator processing

• Split Billing

• Drug replenishment

• Medicaid Carve-In / Carve-Out

• Duplicate Discount prevention

• Diversion prevention

• HRSA / OPAIS

• 340B audit and compliance workflows

Benefits

• Flexible schedule
• Provident Fund
• Work from home

Application Question(s)

• What is your CTC \& ECTC ?
• What is your notice period ?
• This job is initially remote, later hybrid for Coimbatore. Are you comfortable relocating to Coimbatore ?

Experience

• QA Manual: 4 years (Required)
• Healthcare Pharmacy Claims: 2 years (Required)

Work Location

Hybrid remote in Coimbatore, Tamil Nadu