Lead I - Software Testing- EDI, HIPAA, API Testing- US Healthcare

Role description

This role will be responsible for validating provider-facing web applications, EDI transactions, prior authorization workflows, eligibility verification, claims inquiries, and provider data management processes.

The ideal candidate will bring strong Healthcare Payer testing experience with expertise in web application testing, Provider Portal functionality, Provider Portal modernization, Availity integrations, EDI (HIPAA/X12) transactions, API validation, backend data verification, and Azure-based application testing. This role requires close collaboration with business, operations, and development teams to ensure high-quality releases supporting provider experience and operational excellence.

Key Responsibilities

Perform functional, integration, system, regression, smoke, and user acceptance testing for Provider Portal applications.

Validate end-to-end provider workflows including provider registration, eligibility verification, claims status inquiries, prior authorization requests, referrals, and provider maintenance.

Execute comprehensive web application testing, including UI validation, responsive testing, browser compatibility testing, and workflow validation.

Support testing initiatives for Provider Portal modernization, ensuring seamless functionality across modern provider-facing applications and digital user experiences.

Test provider integrations through Availity and other provider connectivity solutions.

Validate EDI (HIPAA/X12) transactions including file processing, business rule validations, acknowledgements, error handling, and reconciliation.

Perform API and interface testing to validate integrations between Provider Portal, Core Administration Systems, and downstream applications.

Perform testing of applications and services deployed within the Microsoft Azure ecosystem, validating cloud-hosted applications, APIs, integrations, and related platform services.

Execute SQL-based backend data validation and data reconciliation testing.

Create, maintain, and execute test plans, test scenarios, and test cases based on business requirements and user stories.

Identify, document, track, and validate defects through resolution.

Collaborate with Business Analysts, Product Owners, Developers, and Provider Operations teams throughout the SDLC lifecycle.

Support SIT, UAT, production validation, release deployment, and post-production verification activities.

Participate in Agile ceremonies including sprint planning, backlog grooming, standups, and retrospectives.

Ensure compliance with HIPAA, PHI/PII protection requirements, and enterprise quality standards.

Required Skills

4+ years of Quality Assurance and Testing experience in the U.S. Healthcare Payer domain.

Strong experience testing healthcare Provider Portals and provider-facing web applications.

Experience supporting Provider Portal modernization initiatives, including testing of modern provider-facing digital applications.

Hands-on experience in web application testing including:

Functional Testing

UI Testing

Regression Testing

Cross-Browser Testing

Responsive Testing

End-to-End Workflow Validation

Strong understanding of Healthcare Payer business processes including:

Provider Operations

Prior Authorization

Claims Processing

Eligibility & Benefits

Provider Data Management

Medicare Advantage

Proven experience with EDI (HIPAA/X12) transactions including:

270/271 Eligibility Inquiry & Response

276/277 Claim Status Inquiry & Response

278 Prior Authorization

837 Professional/Institutional Claims

835 Remittance Advice

834 Enrollment Transactions

Experience testing provider workflows through Availity or similar provider connectivity platforms.

Strong SQL skills for backend data validation and reconciliation.

Experience testing REST APIs using Postman or similar tools.

Knowledge of JSON, XML, and healthcare integration patterns.

Experience working within the Microsoft Azure ecosystem, with familiarity testing Azure-hosted applications and cloud services.

Hands-on experience using Azure DevOps for test management, defect tracking, user story validation, and Agile delivery.

Experience using Azure DevOps, JIRA, or similar test and defect management tools.

Strong analytical, troubleshooting, and communication skills.

Preferred Qualifications

Experience supporting Medicare Advantage, Commercial, or Managed Care healthcare plans.

Experience with healthcare platforms such as Facets, QNXT, HealthRules, or other Core Administration Systems.

Familiarity with Healthcare Interoperability standards including FHIR APIs.

Experience supporting cloud-based healthcare applications within the Microsoft Azure ecosystem.

Experience with Selenium, Playwright, or Cypress test automation frameworks.

Understanding of Provider Directory, Credentialing, Contracting, and Network Management processes.

Exposure to cloud platforms and DevOps practices.

Experience working within Agile/Scrum delivery teams.

Preferred Healthcare Domain Experience

Provider Portal Testing

Provider Portal Modernization

Availity Integration Testing

Prior Authorization Testing

Provider Data Validation

Eligibility & Benefits Testing

Claims Status Inquiry Testing

Provider Directory Testing

EDI Transaction Testing

Medicare Advantage Business Processes

Healthcare Regulatory and HIPAA Compliance Testing

Skills

Web application testing, User acceptance testing, Integration testing, Browser testing, Compatability testing, US Healthcare, Provider, EDI, HIPAA

About UST

UST is a global digital transformation solutions provider. For more than 20 years, UST has worked side by side with the world’s best companies to make a real impact through transformation. Powered by technology, inspired by people and led by purpose, UST partners with their clients from design to operation. With deep domain expertise and a future-proof philosophy, UST embeds innovation and agility into their clients’ organizations. With over 30,000 employees in 30 countries, UST builds for boundless impact - touching billions of lives in the process.