PBM / Pharmacy Claim DOmain

Job description

**Role & responsibilities** - Minimum of **4+ years of QA experience** with **PBM / pharmacy claims domain knowledge** - Experience in writing **SQL queries for data validation** - Ability to **design and execute test cases, test scenarios, and test data** - Hands-on experience in validating **end-to-end pharmacy claims lifecycle**, including: - Member eligibility and benefit verification - Pharmacy/provider validation (NPI, NCPDP ID) - Real-time POS claims adjudication - Pricing logic (AWP, MAC, ingredient cost, dispensing fee, copay, accumulators) - Experience in testing scenarios involving: - Coordination of Benefits (COB) / Other Payer - Prior Authorization (PA) - Formulary and benefit plan rules - Specialty and retail pharmacy claims - Understanding of NCPDP standards (D.0; exposure to F6 preferred) - Ability to interpret **business and technical requirements for testing** Agile/Waterfall models - Good communication skills to **report test results and defects clearly** - Experience in **web services/API testing** using Postman or SoapUI - Basic knowledge of **automation tools and testing practices** Strong interpersonal skills and ability to work with **cross-functional teams** **Preferred candidate profile** PBM / Pharmacy Claim 4 to 9 Years Chennai, Pune, Noida, Bengaluru, Coimbatore, Hyderabad, Mumbai Immediate to 30 days NP if you are interested please share resume to vigneshk15@hexaware.com