Ascendion - Quality Automation Engineer

We are seeking an experienced QE Automation Engineer with strong expertise in Healthcare Enrollment, Eligibility, EDI Transactions, and Test Automation.

The ideal candidate will have hands-on experience validating complex healthcare membership processes, including member enrollment, eligibility verification, retroactive adjustments, premium payments, and reconciliation across healthcare systems.

The role requires strong automation skills using TOSCA or similar automation tools, along with SQL-based data validation and healthcare domain knowledge across Medicaid, Medicare Advantage, Duals/MMP, TRICARE, and Marketplace plans.

Key Responsibilities :

Validate end-to-end member enrollment processes, including :

- Member Add, Change, and Termination transactions.

- Dependent enrollment and maintenance scenarios.

- Dual-enrollment and overlapping coverage validations.

- Test member eligibility workflows across multiple Lines of Business (LOBs).

- Verify enrollment processing accuracy across source systems and downstream applications.

- Perform validation of effective dates, plan selections, coverage periods, and member demographics.

Validate healthcare EDI transactions including :

- 834 Enrollment Transactions.

- 820 Premium Payment Transactions.

- 270/271 Eligibility Inquiry and Response Transactions.

- Perform correlation testing between eligibility responses and enrollment data.

- Ensure premium payment records are correctly linked to member enrollment and eligibility information.

- Analyze transaction failures, discrepancies, and processing exceptions.

- Source enrollment systems.

- Enrollment databases.

- Claims eligibility platforms.

- Downstream healthcare applications.

- Validate enrollment synchronization across multiple systems.

- Identify gaps in membership records, coverage periods, and eligibility status.

- Conduct member-level data comparisons using SQL queries.

- Validate retroactive enrollment changes and adjustments.

- Test Medicaid and Dual/MMP deeming logic.

- Verify eligibility recalculations following retroactive updates.

- Ensure proper handling of backdated member additions, terminations, and reinstatements.

- Design, develop, and maintain automation frameworks using TOSCA or equivalent automation tools.

- Automate enrollment, eligibility, reconciliation, and healthcare transaction testing scenarios.

- Develop reusable automation components for healthcare workflows.

- Integrate automated test suites into CI/CD pipelines.

- Improve test coverage and reduce manual testing effort.

- Database & Backend Validation

- Member-level data validation.

- Effective date comparisons.

- Plan code validation.

- Line of Business (LOB) verification.

- Eligibility status reconciliation.

- Perform backend testing across healthcare data repositories.

- Validate data consistency between source and target systems.

- Create detailed test plans, test cases, and test automation scripts.

- Execute functional, integration, regression, and end-to-end testing.

- Log, track, and manage defects through resolution.

- Collaborate with developers, business analysts, and product teams to resolve issues.

- Participate in requirement reviews and provide testability feedback.

Required Skills :

- Healthcare Domain Expertise

Strong understanding of :

- Medicaid

- Medicare Advantage

- Dual Eligible Programs (MMP/D-SNP)

- TRICARE

- Marketplace/ACA Plans

- Knowledge of enrollment and eligibility business processes.

- Experience with healthcare payer systems.

- EDI & Enrollment Transactions

Hands-on experience with :

- 834 Enrollment Transactions

- 820 Premium Payment Transactions

- 270/271 Eligibility Transactions

- Understanding of HIPAA healthcare data standards.

- Test Automation

Strong experience with :

- TOSCA(Preferred)

- Selenium

- UFT

- Cypress

- Playwright

- CI/CD tools

- Bachelor's degree in Computer Science, Information Technology, Healthcare Informatics, or related field.

- Experience working with Healthcare Payers, Managed Care Organizations (MCOs), or Health Plans.

- Exposure to Healthcare Claims and Eligibility platforms.

- Experience with Agile/Scrum methodologies.

- Healthcare certifications or TOSCA certification are a plus.