QA Tester (PBM)

Job Description – QA Tester (PBM) : Remote
Job Title: QA Tester – PBM
Rate: $50
Job Overview
We are looking for an experienced QA Tester with strong Pharmacy Benefit Management (PBM) domain experience. The candidate will be responsible for functional testing of PBM applications, including claims processing, adjudication, eligibility, benefits, formulary, pricing, and pharmacy transactions.
Key Responsibilities
• Perform functional, integration, regression, system, and UAT testing for PBM applications.
• Test pharmacy claims processing and adjudication workflows.
• Validate member eligibility, benefits, formulary, copay, deductible, pricing, and accumulators.
• Test pharmacy transactions using NCPDP standards, including B1, B2, and B3 transactions.
• Validate NCPDP D.0 transactions and response codes.
• Test pharmacy claim reversals, rejects, resubmissions, prior authorization, and coordination of benefits.
• Validate real-time and batch pharmacy claims processing.
• Develop and execute detailed test scenarios, test cases, and test scripts.
• Perform backend/database validation using SQL.
• Analyze test failures and perform root-cause analysis.
• Validate data across upstream/downstream systems and PBM interfaces.
• Participate in defect identification, tracking, triage, and resolution using tools such as JIRA.
• Work closely with Business Analysts, Developers, Product Owners, and business stakeholders.
• Support SIT, UAT, regression, and production validation activities.
• Validate interfaces between PBM platforms, pharmacies, health plans, and external systems.
• Prepare test execution reports, defect metrics, and testing status updates.
Required Skills
• Strong PBM / Pharmacy Benefits Management domain experience.
• Experience with Pharmacy Claims Adjudication.
• Strong knowledge of NCPDP, preferably NCPDP D.0.
• Experience testing B1/B2/B3 pharmacy transactions.
• Knowledge of eligibility, benefits, formulary, copay, deductible, pricing, and accumulators.
• Strong SQL skills for backend/data validation.
• Experience with JIRA or similar defect management tools.
• Strong understanding of STLC, SDLC, test planning, and defect life cycle.
• Experience with API/interface testing is preferred.
• Excellent analytical and communication skills.
Preferred Skills
• Experience with Medicaid, Medicare, or Commercial healthcare.
• Knowledge of PBM platforms and pharmacy claims systems.
• Experience with ETL/data validation and batch processing.
• Knowledge of EDI healthcare transactions.
• Experience working in Agile/Scrum environments.
• Familiarity with automated testing tools is a plus.