Test Engineer – Pharmacy Claims & PBM Testing

About the role

We are seeking a Test Engineer with deep pharmacy‑claims and PBM testing experience to support an NCPDP D.0 to F6 implementation. The role focuses on validating transaction changes, claim adjudication outcomes, eligibility, coordination of benefits, and ensuring production readiness.

Key responsibilities

• Analyze NCPDP D.0 and F6 implementation requirements, payer sheets, field‑mapping documents and business rules to define test scenarios.
• Create and maintain test plans, test cases, scripts, test data and traceability matrices for pharmacy claim transactions.
• Execute functional, regression, integration, end‑to‑end, batch, database, API/interface, UAT, parallel and production validation testing.
• Develop and run SQL queries to validate claims data, member eligibility, pricing, accumulators and downstream reporting impacts.
• Identify, document, track, retest and close defects using approved defect‑management tools.
• Coordinate testing dependencies with PBM SMEs, business users, developers and downstream application teams, including on‑shore/off‑shore resources.
• Prepare status updates, defect reports, test execution metrics and implementation risk summaries.

Required profile

• Minimum 7 years of QA or software‑testing experience, preferably in healthcare, PBM or pharmacy‑claims environments.
• Hands‑on experience testing pharmacy claims, adjudication, eligibility, benefits, pricing, accumulators and reject codes.
• Working knowledge of NCPDP Telecommunication Standard Version D.0; exposure to Version F6 migration is strongly preferred.
• Strong SQL skills for backend validation and data reconciliation.
• Experience creating test plans, test cases, test scripts, test data and traceability matrices.
• Bachelor’s degree preferred; equivalent industry experience considered.

Required skills

• NCPDP D.0 and NCPDP F6 standards
• Pharmacy‑claims and PBM testing
• SQL query development and data validation
• API/interface and database testing
• Regression, SIT, UAT, parallel and production validation testing
• Defect management and test‑execution tracking tools
• AI automation tools for test automation (as referenced)