QE Engineer - Encounter Data Processing
Job Description:
Healthcare Domain - Encounter data processing X12 837 submissions to Medicaid/Medicare Advantage/TRICARE/Marketplace, acknowledgements, reconciliation, CMS & state companion guides
Core Skills Needed - Facets (REQUIRED), X12 EDI (837P/I/D, 277CA, 999/TA1), SQL, EDI validation tooling (Edifecs), TOSCA/Robot Framework/ Playwright
Core technical & domain requirements:
Facets REQUIRED: claims module familiarity (encounters are derived from Facets claims data); Facets-to-encounter data validation
X12 EDI knowledge: 837P, 837I, 837D (Professional, Institutional, Dental) transaction structure, loops, segments
277CA (Claim Acknowledgement) and 999/TA1 validation
Encounter submission & acceptance rules Medicaid, Medicare Advantage, TRICARE, Marketplace
Edifecs or equivalent EDI validation tooling
SQL for encounter data validation (claim header, detail, member eligibility cross-checks)
TOSCA or Robot Framework test automation
Healthcare payer domain: CMS encounter submission rules, state-specific companion guide
Responsibilities:
Independently design encounter lifecycle scenarios across 837/277CA/999/TA1.
Build and maintain TOSCA/Robot Framework automation for encounter regression.
Lead reconciliation between source claims and submitted encounters.
Own encounter test design and submission-edit validation across LOBs.
Drive automation coverage and mentor analysts on EDI validation.
Conduct RCA on rejections and state/CMS edit failures.
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"Education Qualification"
- Bachelor's degree in Computer Science, Engineering, or related field.