About this role
QE Engineer - Encounter Data Processing Job Description: Healthcare Domain - Encounter data processing X12 837 submissions to Medicaid/Medicare Advantage/TRICARE/Marketplace, acknowledgements, reconciliation, CMS & state companion guides Core Skills Needed - Facets (REQUIRED), X12 EDI (837P/I/D, 277CA, 999/TA1), SQL, EDI validation tooling (Edifecs), TOSCA/Robot Framework/ Playwright Core technical & domain requirements: Facets REQUIRED: claims module familiarity (encounters are derived from Facets claims data); Facets-to-encounter data validation X12 EDI knowledge: 837P, 837I, 837D (Professional, Institutional, Dental) transaction structure, loops, segments 277CA (Claim Acknowledgement) and 999/TA1 validation Encounter submission & acceptance rules Medicaid, Medicare Advantage, TRICARE, Marketplace Edifecs or equivalent EDI validation tooling SQL for encounter data validation (claim header, detail, member eligibility cross-checks) TOSCA or Robot Framework test automation Healthcare payer domain: CMS encounter submission rules, state-specific companion guide Responsibilities: Independently design encounter lifecycle scenarios across 837/277CA/999/TA1. Build and maintain TOSCA/Robot Framework automation for encounter regression. Lead reconciliation between source claims and submitted encounters. Own encounter test design and submission-edit validation across LOBs. Drive automation coverage and mentor analysts on EDI validation. Conduct RCA on rejections and state/CMS edit failures. ___________________________________________________________________________________
"Education Qualification" - Bachelor's degree in Computer Science, Engineering, or related field.