Job Summary

This hybrid role seeks a Product Test Specialist with five to seven years of experience in testing complex health care payer and provider solutions built on Facets and TriZetto Elements platforms. The specialist will validate enrollment benefits claims provider and CAE configurations to ensure accurate and reliable administration for payer and provider clients and support high quality member outcomes.

Responsibilities

Perform end to end testing of Facets enrollment benefit configuration claims provider and CAE modules to ensure that payer and provider processes function accurately and consistently across releases.
Design detailed test scenarios and test cases based on business requirements for enrollment benefits claims and provider functions to confirm that each configuration behaves as expected for diverse member and provider segments.
Execute functional regression and integration tests on Facets and TriZetto Elements solutions to detect defects early and reduce production incidents for payer and provider customers.
Coordinate closely with business analysts and configuration teams to interpret complex payer and provider rules and translate them into clear test coverage for enrollment and benefits workflows.
Validate claims processing scenarios for various product designs and benefit structures to ensure correct adjudication results for different payer plans and provider contracts.
Review and verify provider data setup for networks contracts and participation details to confirm that claims routing and pricing logic aligns with payer policies.
Use CAE tools to analyze configuration effectiveness and identify test gaps so that enrollment and benefit changes are accurately reflected in member and provider transactions.
Document test results defects and configuration issues in a structured manner to support efficient triage root cause analysis and timely resolution by development and configuration teams.
Collaborate in a hybrid work model by joining virtual and in office sessions with cross functional teams to clarify requirements and align on test scope for each release.
Contribute to continuous improvement by suggesting enhancements to test coverage reusable test assets and automation candidates that increase efficiency and reduce cycle time.
Support user acceptance testing by guiding business stakeholders through test scenarios for payer and provider functions and by addressing questions on configuration behavior.
Analyze production issues related to enrollment benefits provider data and claims and replicate them in lower environments to validate fixes and prevent recurrence.
Prepare clear test summary reports and metrics that highlight risk areas configuration gaps and quality trends so that stakeholders can make informed release decisions.

Qualifications

Demonstrate five to seven years of focused experience in testing Facets modules including enrollment benefit configuration claims provider and CAE in large payer environments.
Apply deep hands on expertise in TriZetto Elements and Facets configuration testing to validate complex benefit designs and network structures for payer and provider clients.
Exhibit strong understanding of health care payer and provider domains including enrollment life cycle benefit administration provider network management and claims adjudication concepts.
Utilize advanced test design techniques and defect management practices to ensure thorough coverage and timely closure of issues in Facets and related components.
Communicate effectively in hybrid settings with product owners configuration analysts and quality teams to clarify expectations and share clear test findings.
Adapt quickly to evolving payer regulations product changes and system upgrades while maintaining high quality standards in all test activities for day shift operations.