Role & seniority
- QE Engineer (Encounter Data Processing) — senior/independent contributor expected (design/reconciliation/lead tasks)
Stack/tools
- EDI/X12: 837P, 837I, 837D; 277CA; 999/TA1
- Validation tooling: Edifecs (or equivalent)
- Automation: TOSCA or Robot Framework; Playwright
- Data: SQL
- Domain inputs: CMS rules + state companion guides
- Test/automation support: TOSCA/Robot Framework playbooks; regression automation
Top 3 responsibilities
- Design encounter lifecycle test scenarios across 837 → 277CA/999/TA1 acceptance/validation
- Build/maintain TOSCA/Robot Framework encounter regression automation
- Lead reconciliation between source Facets claims data and submitted encounter outcomes; perform RCA on rejections/edit failures
Must-have skills
- Facets claims/encounter familiarity (encounters derived from Facets claims) + Facets-to-encounter validation
- Strong X12 837 structure knowledge (loops/segments) and payer-specific submission rules
- Ability to validate acknowledgements/acceptance (277CA, 999/TA1)
- SQL for encounter/claim header-detail checks and member eligibility cross-checks
- Proficiency with EDI validation tooling (Edifecs)
Nice-to-haves
- Experience with Medicaid, Medicare Advantage, TRICARE, Marketplace encounter submission specifics
- Playwright usage alongside TOSCA/Robot Framework
- Mentoring/leadership of

Full Description

QE Engineer - Encounter Data Processing

Job Description

Healthcare Domain - Encounter data processing X12 837 submissions to Medicaid/Medicare Advantage/TRICARE/Marketplace, acknowledgements, reconciliation, CMS & state companion guides

Core Skills Needed - Facets (REQUIRED), X12 EDI (837P/I/D, 277CA, 999/TA1), SQL, EDI validation tooling (Edifecs), TOSCA/Robot Framework/ Playwright

Core Technical & Domain Requirements

Facets REQUIRED: claims module familiarity (encounters are derived from Facets claims data); Facets-to-encounter data validation

X12 EDI knowledge: 837P, 837I, 837D (Professional, Institutional, Dental) transaction structure, loops, segments

277CA (Claim Acknowledgement) and 999/TA1 validation

Encounter submission & acceptance rules Medicaid, Medicare Advantage, TRICARE, Marketplace

Edifecs or equivalent EDI validation tooling

SQL for encounter data validation (claim header, detail, member eligibility cross-checks)

TOSCA or Robot Framework test automation

Healthcare payer domain: CMS encounter submission rules, state-specific companion guide

Responsibilities

Independently design encounter lifecycle scenarios across 837/277CA/999/TA1.

Build and maintain TOSCA/Robot Framework automation for encounter regression.

Lead reconciliation between source claims and submitted encounters.

Own encounter test design and submission-edit validation across LOBs.

Drive automation coverage and mentor analysts on EDI validation.

Conduct RCA on rejections and state/CMS edit failures.

"Education Qualification"

Bachelor's degree in Computer Science, Engineering, or related field.

QA Engineer

Full Description