EDI Quality Assurance Analyst - Defect/Bug Tracking System

Description :

We are looking for a detailn oriented EDI QA Analyst to join our Carrier Operations team. In this role, you will be responsible for validating outbound vendor/carrier files, ensuring data accuracy, and maintaining compliance with business and carrier requirements.

You will work closely with internal teams and external vendors to test, validate, and troubleshoot data workflows related to Health & Welfare benefits administration. This is a critical role that ensures high-quality data delivery and smooth integration with external systems.

Key Responsibilities :

Carrier/Vendor File Validation :

- Validate outbound carrier/vendor files (HIPAA 834, EDI formats)

- Ensure file structure, format, and data accuracy before transmission

- Work with vendors and internal teams to resolve discrepancies

Scenario-Based Testing

- Create and execute test scenarios for :

- Eligibility rules

- Enrollment transactions

- Life events

- Ensure system behavior matches business and carrier requirements

End-to-End Data Validation :

- Track and validate data across systems

- Perform data reconciliation using SQL, reports, and control totals

- Ensure consistency from source to final output

Test Planning & Execution :

- Convert business requirements into :

- Test plans

- Test cases

- Validation scenarios

- Maintain traceability between requirements and testing

Test Data Management :

- Prepare and manage test data across systems

- Ensure proper data coverage for all testing scenarios

Defect Management :

- Identify and classify defects (data/config/system issues)

- Log and track issues in tools like JIRA

- Ensure timely resolution and closure

Documentation & Reporting :

- Maintain QA documentation:

- Test cases

- Validation reports

- File layouts

- Provide regular updates on progress and risks

Production Monitoring :

- Monitor carrier responses and error reports (999, rejection reports)

- Investigate and resolve rejected records

- Coordinate reprocessing within SLA timelines

Continuous Improvement :

- Analyze recurring errors and trends

- Suggest process improvements

- Support automation initiatives

Required Skills & Qualifications :

- Bachelors degree in Computer Science or related field

2+ years of experience in :

- EDI / QA / Data validation

- Health Insurance or Benefits Administration

- Strong hands-on experience with SQL

Understanding of :

- HIPAA 834 / EDI transactions

- Eligibility & enrollment processes

- Strong analytical and problem-solving skills

- High attention to detail

Preferred Skills :

- Experience with QA frameworks / Quality Management Systems

- Knowledge of COBRA processes

- Experience with test automation tools

- Familiarity with JIRA or similar tools

- Understanding of relational databases and data models

- Exposure to AI-based testing tools (good to have)

Benefits :

- Health/Medical Insurance

- Opportunity to work in a high-impact, data-driven environment

- Exposure to international clients and carrier integrations

- Learning and growth in QA, data, and automation

Why Join Us :

- Work on complex data systems with real business impact

- Opportunity to build expertise in EDI, QA, and healthcare domain

- Collaborative and growth-focused work environment