About this role
Summary
As a Test Lead (Manual Test, US Healthcare & Medicaid/Pharmacy) at Gainwell, you will be a part of an innovative healthcare technology company with a mission to serve the healthcare needs of our communities. Most importantly, you’ll have the chance to grow and develop as a professional through our exceptional developmental opportunities. This role is strictly involved in the testing of the product and does not involve access to Protected Health Information (PHI) & Personally Identifiable Information (PII) or any secured/confidential client data. The work is limited to application testing and does not include handling or processing of sensitive health information.
Your role in our mission
Show that you’re a real pro as you support creating purpose-built solutions and technologies that help us deliver valuable better health and human services outcomes.
- Perform vital testing, troubleshooting and analysis of application software for complex technical projects
- Design, develop, implement, maintain and monitor critical test processes
- Gather requirements for testing, develop executable test cases and help distribute workload across a team of test engineers
- Coordinate and collaborate with others to analyze requirements to confirm, establish and communicate the defect-causing problem to the right stakeholders
- Assist, as needed, in writing proposals to recommend process and programs
- Do the math by helping prepare estimates for performing the various activities defined in the test plan
What we're looking for
- 14+ years of overall experience with 5+ years specifically in Medicaid pharmacy operations, MMIS/MES systems, PBM functions, or pharmacy claims processing.
- Strong understanding of NDC, HCPCS, quantity limits, and drug pricing methodologies
- Strong understanding of Medicaid PDL, clinical PA criteria, DUR requirements
- Strong understanding of Pharmacy benefit administration and reimbursement models
- Hands‑on experience with EDI transactions (837, 835, 278).
- Experience with test management tools and SQL for data validation.
- Familiarity with Gainwell, Conduent, Optum, Magellan, or other Medicaid pharmacy modules.
What you should expect in this role
- Remote work opportunity
- Shift Timing - 2 PM to 11 PM