Manual QA Engineer - PBM

Requirements:

• Bachelors degree
• 3–5 years of manual QA testing experience in a PBM, health plan, or pharmacy claims environment
• Hands-on experience testing claims adjudication systems and pharmacy benefit configurations
• Working knowledge of pharmacy claims concepts, including NCPDP claim formats, formulary and tiering, copay and coinsurance logic, accumulators, DUR, prior authorization, and rebates
• Ability to create clear, structured test cases and defect reports
• Experience using test case management and defect tracking tools such as Azure DevOps, Jira, TestRail, or similar platforms
• Understanding of the software QA lifecycle, including test planning, execution, regression testing, and UAT
• Strong attention to detail and ability to identify discrepancies in complex rule-based systems
• Strong written and verbal communication skills for cross-functional collaboration
• Preferred: Familiarity with SQL for querying claims and configuration data to validate results
• Preferred: Experience testing across multiple PBM platforms or claims switch vendors
• Preferred: Understanding of HIPAA and PHI handling requirements in a testing environment
• Preferred: Exposure to Agile/Scrum development processes

Responsibilities:

• Design, document, and execute manual test cases and plans for claims adjudication, pricing, formularies, accumulators, prior authorization, and benefit plan configurations
• Verify paid, rejected, and reversed claim outcomes against expected adjudication logic and plan settings
• Conduct regression, functional, and end-to-end testing across releases and configuration changes
• Identify, document, and track defects, including reproduction steps, expected and actual behavior, and business impact
• Work with business analysts, developers, and configuration teams to clarify requirements and verify fixes
• Test edge cases involving copay structures, DUR, accumulator resets, coordination of benefits, and vendor integrations
• Maintain test documentation and data sets, and ensure traceability to requirements
• Participate in Stage cycles and support release sign-off decisions

Technologies:

• Azure
• DevOps
• Support
• JIRA
• QA Testing
• SQL
• Cloud

More

We are seeking an experienced Manual QA Engineer to help our quality assurance team ensure the accuracy, compliance, and reliability of claims adjudication logic, benefit configurations, and system behavior on our PBM platform before production releases. This is a permanent, telecommute position with work hours of 8 a.m. to 5 p.m. The listed annual salary range is $80,000–$110,000. At Randstad Digital, we welcome people of all abilities and are committed to an accessible hiring and interview process. Pay depends on factors such as education, experience, location, job duties, and certifications. Eligible employees may receive medical, prescription, dental, vision, AD&D, and life insurance, short-term disability, and a 401(k) plan. We are an equal opportunity employer and consider applicants without regard to legally protected status. The posting is open for 30 days. Massachusetts law prohibits requiring or administering a lie detector test as a condition of employment or continued employment.

last updated 43 week of 2026