Quality and Testing Manager

Role Overview

The Senior Quality and Testing Manager is tasked with leading the comprehensive testing lifecycle for health insurance, digital platforms, and NPHIES-related technology projects. This role ensures that all systems, integrations, and transactions—ranging from eligibility verification, claims processing, prior authorization, provider network interactions, coding standards, to data exchanges—meet strict standards for functionality, performance, security, and regulatory compliance.

Key Responsibilities

• Plan and execute test strategies including SIT, functional, system integration, regression, and End-to-End testing for all releases.
• Manage test environments, data setup, entry and exit criteria, as well as defect triage and resolution processes to ensure quality deliveries on schedule.
• Lead hands-on testing activities covering health insurance domains such as eligibility, claims, prior authorization, membership, benefits, provider networks, and policy modules.
• Conduct NPHIES transaction testing including Eligibility, eClaims, eAuthorizations, Clinical Coding, Payments, and Attachments to confirm conformity with NHIC, CCHI, and NPHIES standards.
• Oversee automation testing efforts by developing and maintaining automated test scripts for UI, API, and NPHIES flows integrated into continuous integration pipelines.
• Perform non-functional testing including load, stress, volume, and basic security testing on insurance and NPHIES APIs to validate performance and system stability under peak conditions.
• Prepare and share detailed testing reports, dashboards, and traceability matrices with stakeholders to ensure transparency and informed go/no-go decisions.

Required Experience and Skills

• 8 to 10 years of experience in quality assurance and testing management with deep functional expertise in health insurance processes and NPHIES workflow testing.
• Proficiency in manual and automated testing methodologies including functional, integration, regression, system integration, UAT, and end-to-end testing.
• Strong knowledge of health insurance domains such as eligibility determination, claims submission and adjudication, prior authorization, provider network management, and membership benefits.
• Experience with NPHIES standard transactions: Eligibility, eClaims, authorizations, clinical coding, and payment processing.
• Hands-on knowledge of coding standards such as ICD-10-AM and DRG, plus API testing tools like Postman and SoapUI.
• Familiarity with automation frameworks and tools including Selenium, Playwright, RestAssured, and scripting in Python.
• Competence in performance testing tools such as JMeter and LoadRunner.
• Strong SQL skills for backend data validation and reconciliation.
• Basic understanding of health interoperability standards HL7 and FHIR, as well as EDI formats including NPHIES JSON schemas and X12-style structures.
• Excellent skills in test documentation and defect management using tools like Azure DevOps, JIRA, and TFS.
• Ability to interpret and apply regulatory requirements from NHIC, CCHI, and NPHIES frameworks.
• Strong communication, stakeholder management, analytical, and problem-solving skills with aptitude for high-pressure and deadline-driven environments.

Educational Qualifications and Certifications

• Bachelor’s degree in Computer Science, Software Engineering, Information Technology, or related disciplines.
• Professional certification is highly preferred including ISTQB Foundation or Advanced Levels, Certified Software Quality Analyst (CSQA), API testing certifications, performance testing certifications (JMeter, LoadRunner), and health insurance domain certifications.

Main Interactions

• Collaborating with Business Units and Internal Departments.
• Engaging with Executive and Senior Management levels.
• Liaising with Partners, Suppliers, and Vendors.