Senior Executive

This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Senior Executive based in India.

We are seeking a detail-oriented Senior Executive to support quality assurance and claims management within a healthcare payer environment. In this role, you will oversee end-to-end testing activities for claims processing systems, ensuring that business rules, configurations, and system updates function accurately and consistently. You will work with HealthRules Payor (HRP) and Cotiviti tools to validate claims processing logic and support the implementation of rule changes. The position involves developing test plans, executing unit and regression testing, and maintaining quality standards across system updates. You will also contribute to the validation of quarterly CMS dictionary updates and related procedural changes. This opportunity is well suited to a quality-focused professional with healthcare claims knowledge, strong analytical skills, and a commitment to accurate and reliable outcomes.

Accountabilities

• Execute and manage the end-to-end testing lifecycle for Cotiviti within the HealthRules Payor (HRP) application.

• Analyze and validate healthcare claims processing rules, triggers, and scenarios, including FRE, UNB, MUE, non-covered services, and bundled claims.

• Create comprehensive test plans and test cases based on project requirements, business specifications, and system changes.

• Perform full, unit, and regression testing to verify system functionality, identify defects, and ensure consistent processing outcomes.

• Test and validate Cotiviti and CXT rule changes, configurations, and implementations.

• Support the maintenance and testing of HealthRules Payor, including quarterly CMS dictionary updates and associated procedural changes.

• Apply knowledge of healthcare products, member accounts, and contracts to ensure that testing reflects relevant business rules and claims requirements.

• Collaborate with relevant project and technical stakeholders to support implementation quality and resolve testing issues.

Requirements

• Any graduate degree is accepted.

• Approximately 3–6 years of relevant professional experience in quality assurance, claims management, healthcare claims processing, or application testing.

• Knowledge of healthcare claims testing and processing, including Cotiviti rules, triggers, and common claim scenarios.

• Familiarity with HealthRules Payor (HRP) and Cotiviti tools; experience with CXT rule changes is also relevant.

• Experience preparing test plans and test cases and performing end-to-end, unit, full, and regression testing.

• Understanding of healthcare products, member accounts, contracts, and claims processing procedures.

• Strong analytical and problem-solving skills, attention to detail, and the ability to assess system behavior against documented requirements.

• Effective communication, organization, and collaboration skills to support testing activities and implementation projects.

Benefits

• Opportunity to develop expertise in healthcare claims management, quality assurance, and payer system testing.

• Hands-on experience with HealthRules Payor, Cotiviti, and healthcare claims rule implementations.

• Exposure to quarterly CMS dictionary updates and evolving claims processing requirements.

• Opportunities to strengthen technical testing, analytical, and problem-solving capabilities.

• Collaboration with stakeholders involved in healthcare technology, claims operations, and quality management.