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 - Claims Testing Mandatory Skills Description: 4 ye

📌 Health and Benefits Claims (México)
🏢 Luxoft Mexico
📍 México