- Project Description:
- You will be part of a team responsible for testing healthcare claims processing, benefits, pricing, and related workflows for a non-profit healthcare organization in the US.
- The role is focused on validating local claims processing within HealthRules Payer (HRP), including EDI transactions, Blue Card claims, and HRP-to-TPA workflows.
- You will collaborate closely with Product Owners, Business Analysts, Developers, and QA team members across the US, India and Mexico.
- Responsibilities:
- Perform functional and end-to-end testing of healthcare claims processing within HealthRules Payer (HRP).
- Validate local claims processing workflows, business rules, benefits, pricing, and claims adjudication.
- Test and validate EDI 837 files and associated claims-processing workflows.
- Perform testing for Blue Card claims and related business scenarios.
- Validate HRP-to-TPA workflows, including upstream and downstream claims transactions.
- Create and execute test cases and test scenarios based on business and functional requirements.




- Analyze claims-processing results and identify inaccuracies or inconsistencies in business rules, configurations, pricing, and claim payments.
- Document, track, retest, and support resolution of defects identified during testing.
- Support investigation and resolution of production issues related to claims, benefits, and pricing configurations.
- Participate in business requirements and solution-review sessions to identify testing requirements and potential gaps.
- Collaborate with business and IT teams to validate system changes, enhancements, and configuration updates before production deployment.
- Provide subject-matter expertise regarding healthcare claims processing and HRP workflows.
- Maintain appropriate testing and system documentation.
- Mandatory Skills Description:
- Mandatory Skills:
- - Healthcare Claims Processing
- - HealthRules Payer (HRP)
- - EDI 837
- - Blue Card
- - Healthcare Domain Knowledge
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📌 Health and Benefits Claims (Ciudad de México)
🏢 Luxoft Mexico
📍 Ciudad de México