Integration QA & BA

This is a remote position.

Job Description – Healthcare Integration QA / Business Analyst

Required Skills:

• Experience with EDI 834, EDI 837, and EDI 835.

• Experience in FHIR-based data models and APIs.

• Deep understanding of the health insurance landscape, including Enrollment & Eligibility, Billing and Payments, Claims Processing, Contribution Accounting, and System Integrations.

• Strong understanding of healthcare message types and their purposes.

• Experience working with TPAs or payer systems.

• Any relevant certifications in health insurance, healthcare analytics, or related areas would be an advantage.

• Fundamental understanding of Devant / WSO2 or any other similar integration tech stack is necessary.

Role Overview:

We are looking for a highly experienced Healthcare Integration QA / Business Analyst with strong expertise in the U.S. health insurance domain and healthcare interoperability standards. The ideal candidate will possess deep functional knowledge of payer operations, healthcare EDI transactions, FHIR APIs, and integration platforms. This role will work closely with business stakeholders, architects, and development teams to define integration requirements, design solutions, and support successful implementation.

Key Responsibilities:

• Collaborate with business stakeholders to gather, analyze, and document functional and integration requirements.

• Design and support integration solutions between payer systems, TPAs, providers, and third-party applications.

• Analyze and validate healthcare transactions involving EDI 834 (Enrollment), EDI 837 (Claims), and EDI 835 (Claims Payment/Remittance).

• Define integration requirements using FHIR data models, resources, and REST APIs.

• Work with technical teams to map healthcare data between source and target systems.

• Provide functional expertise across payer business processes, including Enrollment, Eligibility, Claims, Billing, and Contribution Accounting.

• Review integration designs and ensure alignment with business requirements and healthcare interoperability standards.

• Support testing activities, defect triage, and production validation for healthcare integrations.

• Work closely with integration developers using Devant, WSO2, or similar middleware technologies.

• Prepare business requirements, functional specifications, process flows, interface documents, and mapping specifications.

• Support production issue analysis and recommend process improvements.

Required Skills & Experience:

• 7+ years of experience in the healthcare or health insurance industry.

• Strong experience with healthcare EDI transactions:

• EDI 834 – Enrollment

• EDI 837 – Healthcare Claims

• EDI 835 – Claim Payment/Remittance

• Experience working with FHIR-based data models, resources, and REST APIs.

• Deep understanding of the U.S. health insurance ecosystem, including:

• Enrollment & Eligibility

• Billing & Payments

• Claims Processing

• Contribution Accounting

• System Integrations

• Strong understanding of healthcare message types and their business purpose.

• Experience working with Third-Party Administrators (TPAs) or payer organizations.

• Experience creating interface specifications, data mapping documents, and functional requirements.

• Strong analytical, problem-solving, and stakeholder management skills.

• Excellent communication skills with the ability to bridge business and technical teams.

Preferred Skills:

• Fundamental understanding of Devant, WSO2, or similar enterprise integration platforms.

• Knowledge of healthcare interoperability standards such as HL7 and X12.

• Familiarity with API integration, middleware platforms, and enterprise integration patterns.

• Exposure to Agile/Scrum delivery methodologies.

• Experience working with cloud-based healthcare integration solutions is an added advantage.