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EDI QA ANALYST
EDI QA ANALYST

EDI QA ANALYST at Opteamix · Mangalore, Bengaluru (Bangalore), Noida, Delhi, Chennai · 1 - 3 years · Profitable · Posted 29 Sep 2026

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EDI QA ANALYST

manipriya Arumugam's profile picture
Posted by manipriya Arumugam
1 - 3 yrs
Best in industry
Mangalore, Bengaluru (Bangalore), Noida, Delhi, Chennai
Skills
EDI
EDI management
Health care administration

The EDI QA Analyst works closely with external vendors during implementations to communicate testing expectations, coordinate validation activities, and address vendor feedback. Operating in a production-adjacent environment, the role ensures data accuracy, file integrity, and carrier readiness through structured test planning, test data preparation, scenario validation, defect identification and classification, and thorough documentation within the carrier file/EDI delivery lifecycle.

In addition, the analyst collaborates cross-functionally with requirements, development, and implementation teams to develop comprehensive test plans, manage testing activities, and work through ticketing queues to ensure timely and high-quality file delivery.

Post-production, the EDI QA Analyst is responsible for ongoing monitoring, review, and resolution of carrier error reports, while identifying trends and opportunities for continuous process improvement.

Key Responsibilities and Duties

Carrier/Vendor File Validation

•     Validate outbound carrier/vendor files (ANSI/HIPAA 834 and related formats) for structural integrity, format compliance, eligibility accuracy, and carrier-specific requirements before transmission.

•     Collaborate with external carriers/vendors and internal teams, including development and operations, to validate file behavior and resolve discrepancies.

Scenario-Based Testing

•     Develop and execute structured test scenarios covering eligibility rules, enrollment transactions, life events, and carrier-specific behaviors across internal and external testing phases.

End-to-End Data Reconciliation

•     Trace and reconcile data from upstream systems through platform outputs to final vendor files using SQL, reports, and control totals to ensure data integrity.

•     Test Planning & Requirements Traceability

o  Translate carrier/vendor and business requirements into structured test plans, reusable test cases, and traceable validation scenarios aligned to standardized templates.

 

•     Test Data Preparation

o  Identify, prepare, and manage representative test populations across systems and reporting environments to support validation cycles.

•     Defect Identification & Routing

o  Analyze validation results, classify defects (requirements, configuration, data, system issues), and manage QA tickets through defined workflows, ensuring proper routing, status tracking, ownership, and timely closure.

•     Documentation & Continuous Improvement

o  Provide regular status updates on QA progress, risks, and dependencies aligned to timelines and release schedules.

o  Maintain QA documentation (test plans, validation evidence, file layouts, queries, defect patterns) while building reusable test assets, vendor test plan libraries, and supporting future automation initiatives.

o  Help establish and maintain a vendor test plan library in support of all vendor relationships.

o  Drive automation and validation improvements.

•     Production Monitoring & Carrier Error Resolution

o  Review carrier acknowledgement and error reports (e.g., 999, rejection reports)

o  Investigate and resolve rejected records.

o  Coordinate corrections and reprocessing.

o  Ensure timely resolution within SLA.

•     Trend Analysis & Continuous Improvement – Post-production

o  Analyze recurring carrier errors and identify patterns.

o  Provide insights into upstream data or configuration issues.

o  Recommend improvements to reduce rework and increase first-pass success.

Required Qualifications

•     Bachelor’s degree in Computer Science or a related technical field (or equivalent experience).

•     Minimum of 2 years of experience in health insurance or Health & Welfare (H&W) benefits administration.

•     Experience working with carrier files, EDI transactions, or HIPAA 834 files in a production or operational environment.

•     Strong understanding of eligibility and enrollment processes, including effective date logic and life event transactions.

•     Hands-on experience with SQL for data validation, reconciliation, and defect analysis.

•     Strong analytical skills with a high level of attention to detail, especially in regulated environments with low tolerance for error.

Preferred Qualifications

•     Familiarity with QA best practices and Quality Management Systems (QMS), including frameworks that ensure consistent compliance with customer and regulatory requirements while driving continuous improvement and efficiency.

•     Experience with EDI testing and carrier integration environments.

•     Exposure to COBRA processes within benefits administration.

•     Experience with test automation and test case management tools.

•     Familiarity with AI-assisted testing or quality engineering practices.

•     Experience in preparing, validating, and analyzing test data across multiple systems.

•     Solid understanding of data models and relational database concepts.

•     Experience using defect tracking and ticketing systems such as JIRA (or similar tools).

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About Opteamix

Founded :
2012
Type :
Services
Size :
100-1000
Stage :
Profitable

About

Opteamix is a digital automation technology consulting firm with deep expertise in Application Development, Robotic Process Automation, AI, DevOps, Enterprise Mobility, ITOps, and Test Automation Services. We are headquartered in Denver, Colorado with a wholly-owned delivery center in Bangalore, India.


We ensure that our clients are always ahead of the curve by leveraging futuristic technologies to co-create a better tomorrow, today. Since the founding of the company in 2012, we have focused on solving our client’s business problems using digital technology.


Keeping a close eye on current market trends and emerging technologies is how we understand and further strengthen our technical know-how. We combine deep business knowledge and cutting-edge technology solutions to deliver innovative business solutions leveraging global technology delivery practices.


We deliver a wide spectrum of technology solutions - from legacy technologies to the next generation Robotic Process Automation, AI, and Machine Learning solutions.

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• Proficient in the Microsoft Office suite.

• Working knowledge of agentic AI and AI-assisted testing tools; ability to apply prompt engineering, critically evaluate AI-generated test artifacts, and maintain human oversight and accountability over AI-driven testing outputs.

• Hands-on experience with the Playwright test automation framework and with Claude Code or similar agentic coding tools for generating, executing, and validating automation scripts.

• Experience with the system development lifecycle. Extensive knowledge of test engineering methodologies.

• Working knowledge of testing concepts, verification and validation techniques, defect management, quantitative methods, risk management, and measurement programs.

• Understanding of relational database principles, client/server infrastructure, and n-tier architecture concepts.

• Working knowledge of defect tracking, quality principles, and testing tools.

• Knowledge of MS SQL Server, AWS Postgres, Web, Mobile, Accessibility, and Middle tier testing.


Professional Competencies -

• Ethical decision making: acts in the best interest of the organization, demonstrates integrity in all situations, and holds self and others to the organization's values.

• Focus on business results: understands the financial implications of business decisions, sets ambitious goals, and prioritizes sustained business performance.

• Honoring commitments: meets or exceeds performance expectations and inspires trust by delivering on promises.

• Embracing change: participates actively in the change process, shows resiliency and commitment during times of change, revises priorities and adapts project plans or work tasks as

needed, and takes initiative to improve own capabilities as the business changes.

• Service delivery: delivers service in compliance with contracted agreements, meets or exceeds established performance standards, and uses available tools and systems to deliver timely, accurate work.

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Shubham Vishwakarma

Full Stack Developer - Averlon
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