QA Analyst US healthcare Benefit configuration

About the role

The Senior Healthcare Data QA Analyst – Pharmacy Claims is responsible for leading pharmacy claims data validation, Rx file reconciliation, accumulator accuracy review, and production data quality monitoring across VBA & G-GBAS (Claim Adjudication system) during hyper care and ongoing operations.

What you'll do

• Execute Pharmacy Claims Data QA activities for Rx hypercare across VBA and G-GBAS, including production monitoring, file validation, and issue tracking
• Perform source-to-target validation between PBM files, raw tables, normalized tables, VBA, G-GBAS, reporting outputs, and downstream archive tables
• Support accumulator validation for deductible, out-of-pocket, copay, coinsurance, and benefit maximum amounts across group-specific plan designs
• Document QA evidence, reconciliation results, exceptions, defects, root cause findings, and sign-off status in accordance with audit and governance expectations
• Work closely with Rx Services, EDI, Technology, Claims Operations, Plan Build, Reporting

What you need

• 8–14 yrs of experience
• SQL
• VBA
• Reconciliation
• Regression testing
• B.Tech or B.E. or B.Sc or BCA

Good to have

• JIRA
• Claims processing
• Root cause analysis
• Power BI
• Azure