Facets QA Lead

Role :: Facets QA Lead

Location :: Kansas City, MO- Onsite

Fulltime_ Permanent Role

Job Description

Strong SME knowledge in Healthcare Claims Processing lifecycle

• Expertise in EDI formats – 837 (P/I/D), 835, 834

• Hands-on experience in Facets (Claims + Enrollment modules)

• Proficiency in Azure DevOps (ADO) for QA tracking

• Knowledge of HIPAA compliance and payer systems

• 8+ years of experience in Healthcare QA/Testing

• 4+ years of experience as Test Lead in Facets projects

• Deep understanding of Claims Adjudication & Payment workflows

• Experience in handling claims denials, adjustments, and reprocessing

• Strong exposure to EDI claim and remittance transactions

• Experience in mocking and validating EDI files (837/835/834)

• Knowledge of ITS claims processing (SF, DF, RF)

• Experience in Member Enrollment workflows (Medicaid, Medicare, ACA)

• Understanding of Billing lifecycle for member enrollment

• Hands-on experience with ADO Test Plans, Test Suites, and Defect tracking

• Ability to perform data validation and reconciliation activities

• Strong experience in functional and end-to-end testing

• Familiarity with Agile/Scrum methodologies

• Excellent stakeholder communication and coordination skills

• Experience in risk identification, defect triage, and RCA

Roles & Responsibilities

• Lead end-to-end testing for Claims, Enrollment, and Billing modules

• Act as SME for Claims Processing and EDI transactions

• Validate Facets Claims and Membership workflows

• Design and execute test strategies, test plans, and test cases

• Perform EDI validation (837, 835, 834) including mock data creation

• Manage defect lifecycle, triage, and resolution tracking in ADO

• Ensure HIPAA compliance in all testing activities

• Validate ITS claims processing across SF, DF, RF flows

• Drive quality metrics, reporting, and release sign-offs

• Collaborate with business, development, and partner teams for E2E validation