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Jobs via Dice • United States
Role & seniority: QA Analyst – Payment Integrity and Claims Repricing (mid-level to senior individual contributor)
Stack/tools: SQL for data validation; test case development; regression testing; traceability matrices; defect logging and documentation of pricing/calculation logic (CPT/HCPCS, DRG/APC, Medicare pricing)
Claims repricing validation across provider contracts, fee schedules, CPT/HCPCS, DRG/APC logic, and Medicare-based pricing; verify allowed amounts, patient responsibility, and payer liability; test in-network vs out-of-network scenarios; validate multiple pricing methodologies
Functional and regression testing: create and execute test cases, perform regression tests, validate edge cases
Data validation and documentation: write SQL queries to validate financial fields, compare expected vs actual amounts, identify duplicates; document pricing discrepancies with calculations and maintain traceability; log defects with reproducible steps and impact
Strong SQL for data validation and reconciliation
Experience designing and executing QA tests for pricing/claims
Understanding of healthcare pricing concepts (CPT/HCPCS, DRG/APC, Medicare-based pricing)
Ability to verify allowed amounts, patient responsibility, and payer liability
Defect logging and traceability matrix maintenance
Prior work in payment integrity or healthcare claims testing
Familiarity with pr
Dice is the leading career destination for tech experts at every stage of their careers. Our client, B2B Technology, is seeking the following. Apply via Dice today!
Our direct client is looking for QA Analyst – Payment Integrity and Claims Repricing.
Location: Remote, CTH after 6 months
Please send me your rate, contact details and current location.
Key Responsibilities
Claims Repricing Validation
Functional & Regression Testing
Creating and executing test cases Perform regression testing Validate edge cases (
Data Validation
Create detailed test cases and test scenarios. Document pricing discrepancies with calculation breakdown. Log defects with reproducible steps and financial impact. Maintain traceability matrix.