Senior Benefits Configuration Tester

Job Description

REQUIREMENTS

• 2-4 years of experience in benefits configuration or testing within the healthcare industry
• Associate degree or equivalent work experience
• Strong understanding of benefit design standards, including HIPAA and NCPDP
• Proficiency in Microsoft Excel
• Strong critical thinking skills and the ability to analyze data to draw logical conclusions
• Excellent written and verbal communication skills for cross-functional collaboration

Preferred

• Experience in Pharmacy Benefit Management (PBM) or managed care

RESPONSIBILITIES

• Organize testing suites, create test plans, and submit complex test cases to validate benefit configuration accuracy
• Serve as a key liaison with senior Benefit Operations members to resolve configuration discrepancies and clarify plan designs
• Provide support, guidance, and peer review for junior team members regarding claims adjudication and upstream/downstream processes
• Perform advanced logic validation for Clinical/Prior Authorization and Financial Accumulators, ensuring accurate out-of-pocket maximums and cost-shares
• Document detailed defect reports and assist in developing process improvements for efficiency and accuracy

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