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Position Summary

As a Benefit Testing Manager, you will be part of Client Benefit Services QA team that is engaged across multiple functions including Clinical and Benefit Organization, with particular emphasis on solving problems, process improvement and increase automation opportunity within testing team. You will have the opportunity to utilize your PBM technical skills and logical skills to analyze the business process, insert technology to solve problems and improve efficiency of Benefit testing operation. You will be responsible for performing analytical skill to review different Medicaid state compliance Benefit programs and translate those into business rule and define test strategy and scripts to validate the same.

• Take full ownership and serve as subject matter expert for testing all client's benefit plan designs in the Benefit space of Utilization Management and Formulary, and present Test Results to Internal Benefits team and External Clients.
• Understanding client needs and Benefit requirements, translate into Test Scenarios to validate Benefit Configuration and Benefits Coding.
• Expertise on EZTEST (claim processing tool), Sales force, EZQYERY, EXCEL Macro, Formulary management system and Benefit Serve/Benefit builder.
• Translate CMS and state mandate Benefit program/rule and define business rule and validate before code promotion to production.
• Facilitating internal and external meetings and presentations to provide status updates and ensure Benefit configuration accuracy for Client's requirement.
• Building relationships with key client partners through a consultative approach to fully understand Benefit components of client benefit plan design needs.
• Define Benefit test requirements, create test plans, and execute test scenarios, capture test results, present test results to all stakeholders.
• Assess project risks and provide risk mitigation plans, weekly statuses with leadership and other stakeholders.
• Develop process improvement initiatives in support of department efficiency. Pinpoint areas of opportunity and training needs.
• Advise colleagues in performing set ups and testing for various benefit plan designs in Benefit space of client requirements.
• Work through the various phases of the project until all issues have been resolved, cleanup complete and all reportable items are closed to the satisfaction.
• Identify Benefit testing gap for Commercial, Medicaid, Medicare, and Exchange Line of Business
• Create Benefit Test Strategy for identified Benefit testing gap areas.
• Propose/develop testing automation tools to enhance testing accuracy and rapid turnaround.

• Excellent communication (Verbal and Written) and collaboration skills.
• Demonstrated ability to manage and organize projects from start to completion.
• Computer proficiency in MS Office applications (Microsoft Word; Microsoft Excel, Microsoft PowerPoint, and Microsoft Outlook).
• Claim Adjudication knowledge.
• PBM and Healthcare knowledge.
• Formulary and Utilization Management knowledge is mandatory.
• EZQUERY/Sequel hands-on.
• Expertise in defining Benefit test conditions.
• Ability to coach, train, and mentor resources with Benefit testing process.
• Claim processing tool (EZTEST), Sales force.
• Medicaid state specific Benefit program knowledge.