Testing and Quality

Role Purpose

1-QA Planning & Execution

• Develop test plans, test scenarios, and test scripts for all releases.
• Lead hands on execution of SIT, functional, system integration, and regression testing.
• Ensure readiness of test environments, test data, and entry/exit criteria.
• Manage defect triage, reporting, and closure.

2-Health Insurance & NPHIES Testing

• Conduct hands on testing for eligibility, claims, prior authorization, membership, benefits, provider network, and policy modules.
• Execute testing for NPHIES transactions: Eligibility, eClaims, eAuthorizations, Clinical Coding, Payments, and Attachments.
• Validate business rules, product configurations, and actuarial logic.
• Execute end-to-end process testing across TPA and insurance systems.
• Ensure compliance with NHIC, CCHI, NPHIES standards.
• Conduct interoperability and integration testing with external stakeholders.
• Validate coding standards: ICD 10 AM, DRG etc.

3-Test Automation Execution

• Develop automated test scripts for UI, API, and NPHIES flows.
• Execute automated regression cycles and maintain automation suites.
• Integrate automation into CI/CD pipelines for continuous testing.

4-Non Functional Testing

• Conduct load, stress and volume tests for insurance and NPHIES APIs.
• Validate API performance and stability under peak loads.
• Execute basic security testing (vulnerabilities, access validation, API security).

5-Reporting & Metrics

• Prepare daily/weekly test reports, dashboards, and traceability matrices.
• Publish quality status, defect summaries, and readiness reports to stakeholders.
• Ensure test documentation, evidence, and audit trails are maintained.

Skills

• Extensive hands on experience in functional, integration, regression, UAT, E2E testing
• Strong domain expertise in health insurance, covering:
• Eligibility
• Claims (Submission, Adjudication, Rejection workflows)
• Prior Authorization
• Provider Network

• Membership & Benefits

• Proven experience executing NPHIES testing (Eligibility, eClaims, eAuthorizations, Clinical Coding transactions)
• Hands on validation of coding standards: ICD 10 AM,
• Strong experience in API testing using Postman, SoapUI
• Experience executing automation testing (UI/API/Mobile App)
• Experience conducting performance, load, and volume testing
• Strong stakeholder management and cross functional coordination skills
• Excellent defect management, test documentation, and reporting capabilities
• Ability to interpret regulatory requirements from NPHIES, NHIC, and CCHI
• Strong analytical, troubleshooting, and problem solving skills
• Ability to work in fast paced environments with strict deadlines

Education