• Should have strong MMIS health care domain experience and should have good knowledge of Medicaid and Medicare.

• Should have hands-on experience on claims processing and Adjudication processes.
• Must have good experience in Reference code/data sets required in Claims adjudication.
• Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
• In depth understanding of Claims and Claims lifecycle Claim System:
• Testing knowledge and E2E Testing:
• Validate the entire flow from claim intake to payment and reporting.
• Interface testing - Test integration points between systems
• Design test case based on business rules, coverage policies, and system configurations.
• Familiarity with test management tools like ADO, JIRA,
• Interface/API testing tools like Postman

Technical Skills

• SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).
• - EDI Tools: Validating X12 files.
• - Interface Testing: Understanding how data flows between systems and formats and use tools like postman