QA Analyst - Pharmacy Benefit Management (PBM)
Technology
Job Description
QA Analyst – Pharmacy Benefit Management (PBM)
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Location: Remote (USA Only)
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Employment Type: Full-Time
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We are seeking a QA Analyst with Pharmacy Benefit Management (PBM) experience to join our growing team. The ideal candidate will have strong experience in manual and/or automated testing within PBM systems and a deep understanding of pharmacy claims processing, benefit plans, formulary management, and eligibility verification.
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Key Responsibilities
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- Design, create, and execute test cases, test plans, and test scenarios.
- Validate PBM applications related to claims adjudication, eligibility, benefits, formulary, prior authorization, and rebate processing.
- Perform functional, regression, integration, system, and UAT testing.
- Analyze business requirements and identify test coverage gaps.
- Track, document, and verify defects throughout the SDLC.
- Collaborate with Business Analysts, Developers, Product Owners, and stakeholders.
- Support Agile/Scrum methodologies and participate in sprint activities.
- Ensure compliance with healthcare and pharmacy industry standards.
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Required Qualifications
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- 6+ years of QA/testing experience.
- 3+ years of hands-on experience in Pharmacy Benefit Management (PBM).
- Strong knowledge of:
- Pharmacy Claims Adjudication
- Formulary Management
- Eligibility & Enrollment
- Prior Authorization
- Medicare Part D / Commercial Pharmacy Benefits
- Experience with test management and defect tracking tools such as Jira, ALM, or Azure DevOps.
- Strong SQL skills for backend data validation.
- Excellent analytical and communication skills.
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Preferred Qualifications
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- Experience with Automation Testing (Selenium, Cypress, or similar tools).
- Knowledge of HIPAA and healthcare regulations.
- Experience working in Agile environments.
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