[Remote] Healthcare Claims Finance Tester

Note: The job is a remote job and is open to candidates in USA. Dice is seeking a Healthcare Claims Finance Tester to lead the finance domain for MMIS health care projects. This role involves driving test strategies, analyzing business requirements, and ensuring quality processes while coordinating with customers on delivery and deployments.ResponsibilitiesPlay the role of Finance Domain lead for MMIS health care projectsDrive the test strategy and process, domain knowledge, perform analysis of business requirements, designs and develops test plans, ensures quality process, coordinates with customers on delivery and deploymentsWorks in team environment and provides testing guidance throughout the entire life cycleResponsible to meet customer expectations, troubleshoot problems in the application and assisting customers in implementation decisionsValidate Claims payment system to ensure accurate and consolidated reimbursements to payees (provider, member and other) within a defined payment cycleMust have good experience with claims processing concepts, along with the provider, member enrolment and care management conceptsShould be able to run queries and perform basic system analysis, RCA etcMust have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasksValidate the entire flow from claim intake to payment and reportingInterface testing - Test integration points between systemsDesign test case based on business rules, coverage policies, and system configurationsFamiliarity with test management tools like ADO, JIRAInterface/API testing tools like PostmanSQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan)EDI Tools: Validating X12 filesUnderstanding how data flows between systems and formats and use tools like postmanCreate test plans, test summary reports, and traceability matricesCollaborate with cross-functional teams including developers, SME s and BA sSkillsCandidate should have strong health care domain experience and should have good knowledge of Medicaid and MedicareCandidate should have hands-on experience on claims processing and Adjudication processesCandidate should have hands-on experience and strong knowledge on processing payouts, Account receivables and Receipts creationCandidate should have hands-on experience of executing payment cycle process and ability to analyze batch job failuresCandidate should have hands-on experience of executing payment cycle process and generating Paper RA, 835 and 820 premium paymentGood knowledge and Strong hands-on experience on Fiscal pend, budget updates processingCandidate should have hands-on experience generating EFT/ChecksGood knowledge and Strong hands-on experience on Airflow batch job scheduler to execute different batch jobsGood knowledge and Strong hands-on experience on 1099 generation processGood Knowledge and Strong hands-on experience on generating Account receivable, 1099 and warrant due letters generation processGood Knowledge and Strong hands-on experience on generating Payouts, AR, Receipts and payment cycle cognos reportsGood Knowledge and Strong hands-on experience Financial outbound and Inbound interfacesGood knowledge on Finance reportsAble to validate Claims payment system to ensure accurate and consolidated reimbursements to payees (provider, member and other) within a defined payment cycleMust have good experience with claims processing concepts, along with the provider, member enrolment and care management conceptsMust have good experience in Reference code/data sets required in Claims adjudication including not limited to CPT, CDT, HCPCS, ICDsShould be able to run queries and perform basic system analysis, RCA etcMust have excellent written and spoken communication skillsShould be able to multitask between internal team and clients based on priority tasksValidate the entire flow from claim intake to payment and reportingInterface testing - Test integration points between systemsDesign test case based on business rules, coverage policies, and system configurationsFamiliarity with test management tools like ADO, JIRAInterface/API testing tools like PostmanSQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan)EDI Tools: Validating X12 filesInterface Testing: Understanding how data flows between systems and formats and use tools like postmanMinimum of 5+ years of experience in health care experience especially in MMIS domainCapability to think out-of-the-box to create new solutions as neededAbility to validate Test scenarios and test plans, test dataShould be able to Review requirements, documentation and create Requirements Traceability matrix (RTM)Should have excellent communication (written and spoken) skills to engage with different stakeholders like QA/dev team, clients, end users of Clients and Business UnitsAbility to assess current functionality available in a product vis a vis market trends, regulatory requirements to be implemented in future version of the productAbility to drive and share the requirements with Technical and Architects regarding product features to be implementedTest Planning & Reporting: Create test plans, test summary reports, and traceability matricesCommunication: Collaborate with cross-functional teams including developers, SMEs and BAsCompany OverviewDice is the go-to career marketplace for tech professionals. It was founded in 2010, and is headquartered in Drachten, Friesland, NLD, with a workforce of 201-500 employees. Its website is https://www.or-quest.nl/.