ACAS / Healthcare Claims Tester - US Healthcare - PAN India - 3+ Years

ACAS / Healthcare Claims Tester - US Healthcare - Remote - 3+ Years

We are looking for an experienced Healthcare Claims Tester with 3+years of experience in US Healthcare Claims Testing and hands-on exposure to ACAS and Rumba. The ideal candidate is bringing strong expertise in claims adjudication, benefit configuration, claims validation, and end-to-end testing. Experience with Aetna and Professional and Institutional claims is being required.

Location: Remote

Your Future Employer: Join a leading organization in the US Healthcare domain, offering the opportunity to work on complex healthcare claims systems and gain exposure to end-to-end claims testing and adjudication processes.

Responsibilities

1. Performing end-to-end testing of healthcare claims processed through the ACAS platform.
2. Validating claim adjudication outcomes, pricing logic, payment calculations, and benefit application.
3. Executing test cases covering overpayment recovery, refund processing, and claims rework workflows.
4. Validating payment integrity edits and ensuring accurate implementation of business requirements.
5. Performing functional, regression, integration, system, and UAT testing.
6. Reviewing and validating member, provider, claim, and benefit attributes.
7. Testing Professional and Institutional healthcare claims.
8. Validating claims processing across Medicare, Medicaid, and Commercial plans.
9. Analyzing test results, identifying defects, documenting findings, and coordinating with development teams for resolution.
10. Supporting release validation, production verification, and post-implementation testing.
11. Preparing test scenarios, test cases, test plans, traceability matrices, and execution reports.
12. Collaborating with business and technical stakeholders to understand requirements and develop comprehensive testing scenarios.

Requirements

1. Holding 3+ years of experience in US Healthcare Claims Testing.
2. Having hands-on experience with ACAS (Aetna Claims Adjudication System).
3. Having mandatory experience working for Aetna.
4. Having experience with ACAS / Rumba.
5. Demonstrating strong understanding of Healthcare Claims Adjudication and Claims Testing.
6. Having knowledge of Member Enrollment, Provider Validation, and Benefit Configuration.
7. Having experience testing Professional and Institutional claims.
8. Having good understanding of Medicare, Medicaid, and Commercial plans.
9. Having knowledge of Deductible, Copay, Coinsurance, and Out-of-Pocket calculations.
10. Demonstrating strong defect management and testing skills, along with understanding of STLC, test execution, defect lifecycle, and regression testing.

Whats in it for you

1. Opportunity to work on a specialized US Healthcare claims testing mandate.
2. Exposure to ACAS, Rumba, claims adjudication, and end-to-end claims processing.
3. Opportunity to work across Professional, Institutional, Medicare, Medicaid, and Commercial claims.
4. Scope to strengthen expertise in healthcare technology and testing.

Reach Us: If you feel this opportunity is well aligned with your career progression plans, please feel free to reach me with your updated profile at Yashika.malhotra@crescendogroup.in

Disclaimer: Crescendo Global is an equal opportunity employer and makes employment decisions based on merit and business requirements. We do not discriminate on the basis of gender, race, religion, caste, disability, age, or any other legally protected characteristic.

Note: Due to the high volume of applications, candidates who do not hear back from us within one week should assume that their profile has not been shortlisted.

Fraud Alert: Scammers can misuse Crescendo Globals name for fake job offers. We never ask for money, purchases, or system upgrades. Verify all opportunities at www.crescendo-global.com and report fraud immediately. Stay alert!

Profile Keywords
ACAS, Rumba, Aetna, Healthcare Claims Testing, Claims Adjudication, US Healthcare, Professional Claims, Institutional Claims, Benefit Configuration, Regression Testing, Medicare, Medicaid