SDET Engineer – Member Enrollment & Eligibility (Healthcare Domain)

We are seeking a highly skilled SDET Engineer – Member Enrollment & Eligibility with deep expertise in Facets, Healthcare EDI Transactions, Enrollment Processing, Eligibility Validation, and Test Automation. This role is ideal for professionals experienced in managing complex enrollment ecosystems across Medicaid, Medicare Advantage, Duals, TRICARE, and Marketplace programs.

Key Skills Required

Facets (Mandatory) – Membership & Enrollment Modules
X12 EDI Transactions (834, 820, 270/271)
Enrollment Reconciliation & Validation
SQL Data Validation & Analysis
TOSCA Automation Testing
Azure DevOps (ADO)
Healthcare Payer Domain Expertise

Healthcare Domain Experience

Medicaid
Medicare Advantage (MA)
Duals / MMP Programs
TRICARE
Marketplace Plans

Core Functional Expertise

Enrollment & Membership Management

Member Enrollment Processing
Subscriber Configuration Validation
Member Add / Change / Term Scenarios
Dependent Enrollment Validation
Dual Enrollment Scenarios

X12 EDI Expertise

834 Benefit Enrollment & Maintenance Transactions
820 Premium Payment Validation
270 Eligibility Inquiry
271 Eligibility Response Validation

Eligibility & Reconciliation

Eligibility Cross-Validation
Enrollment Reconciliation Across Systems
Effective Date Validation
Plan Code Verification
Line of Business (LOB) Validation

Healthcare-Specific Processes

Retroactive Enrollment Adjustments
Deeming Logic Validation
Medicaid & Dual Eligibility Rules
Premium Payment Linkage Validation

Key Responsibilities

Design and execute comprehensive enrollment and eligibility test scenarios, including:

* New Enrollments
* Member Changes
* Terminations
* Retroactive Adjustments
* Dual Enrollment Cases

Validate end-to-end 834 enrollment transactions and Facets integration workflows

Lead 820 premium payment linkage validation and reconciliation testing

Perform 270/271 eligibility correlation testing across integrated healthcare systems

Conduct enrollment reconciliation between:

* 834 Source Systems
* Enrollment Databases
* Claims Platforms
* Eligibility Systems

Build and maintain automation frameworks using TOSCA or equivalent tools

Validate member-level data using SQL, including:

* Effective Dates
* Plan Codes
* Coverage Periods
* LOB Flags
* Eligibility Indicators

Own offshore enrollment testing initiatives across multiple healthcare programs

Drive automation coverage, quality improvements, and mentor QA analysts

Conduct Root Cause Analysis (RCA) for:

* Enrollment Discrepancies
* Eligibility Issues
* Reconciliation Failures
* Premium Payment Linkage Errors

Preferred Qualifications

Strong Healthcare Payer Domain Experience
Expertise in Enrollment & Eligibility Systems
Experience with Medicare, Medicaid, and Marketplace Programs
Knowledge of Regulatory Enrollment Compliance Requirements

Why Join?

Work on large-scale Healthcare Enrollment & Eligibility platforms
Exposure to complex payer ecosystems and regulatory programs
Opportunity to lead automation and quality engineering initiatives
Collaborate with highly skilled healthcare technology teams
Hybrid work model with excellent career growth opportunities

Interested candidates can share their updated resume at:

Email: [email removed]
WhatsApp: +91 7013663419

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