Test Lead with PBM (Pharmacy Benefit Management)

As a Test Lead (Manual Test, US Healthcare & Medicaid/Pharmacy) at Gainwell, you will be a part of an innovative healthcare technology company with a mission to serve the healthcare needs of our communities. Most importantly, youll have the chance to grow and develop as a professional through our exceptional developmental opportunities. This role is strictly involved in the testing of the product and does not involve access to Protected Health Information (PHI) & Personally Identifiable Information (PII) or any secured/confidential client data. The work is limited to application testing and does not include handling or processing of sensitive health information.

Role & responsibilities

• Perform vital testing, troubleshooting and analysis of application software for complex technical projects
• Design, develop, implement, maintain and monitor critical test processes 
• Gather requirements for testing, develop executable test cases and help distribute workload across a team of test engineers
• Coordinate and collaborate with others to analyze requirements to confirm, establish and communicate the defect-causing problem to the right stakeholders
• Assist, as needed, in writing proposals to recommend process and programs
• Do the math by helping prepare estimates for performing the various activities defined in the test plan 

Preferred candidate profile

• 14+ years of overall experience with 5+ years specifically in Medicaid pharmacy operations, MMIS/MES systems, PBM functions, or pharmacy claims processing.
• Strong understanding of NDC, HCPCS, quantity limits, and drug pricing methodologies
• Strong understanding of Medicaid PDL, clinical PA criteria, DUR requirements
• Strong understanding of Pharmacy benefit administration and reimbursement models
• Handson experience with EDI transactions (837, 835, 278).
• Experience with test management tools and SQL for data validation.
• Familiarity with Gainwell, Conduent, Optum, Magellan, or other Medicaid pharmacy modules.

Perks and benefits

• Remote opportunity