Senior Executive

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

As a Senior Executive in Total Quality Management and Claims Management, you will play a key role in ensuring the accuracy, reliability, and quality of healthcare claims processing systems. You will manage end-to-end testing activities for Cotiviti within the HealthRules Payor (HRP) application, helping maintain compliance with evolving healthcare rules and requirements. Your work will include validating claims processing logic, testing system updates, and supporting quarterly updates to Centers for Medicare & Medicaid Services (CMS) dictionaries and procedures. You will collaborate with relevant teams to develop comprehensive test plans, execute test scenarios, and identify potential issues before implementation. Through detailed analysis and rigorous testing, you will help improve system performance, claims accuracy, and operational quality. This role offers an opportunity to apply your technical testing expertise in a structured healthcare technology environment.

Accountabilities

• End-to-End Testing Management: Plan, execute, and manage the complete testing lifecycle for Cotiviti within the HealthRules Payor (HRP) application, ensuring that system changes meet business and technical requirements.

• Claims Processing Validation: Test and validate healthcare claims processing scenarios, including Cotiviti rules and triggers such as FRE, UNB, MUE, non-covered services, and bundled claims.

• Test Planning and Documentation: Develop comprehensive test plans, test cases, and test scenarios based on project specifications, business requirements, and system changes.

• Functional and Regression Testing: Perform unit, functional, full-cycle, and regression testing to verify system functionality, identify defects, and ensure that existing processes remain unaffected by new implementations.

• Application Maintenance and Updates: Analyse and test changes within HealthRules Payor to support system maintenance, quarterly CMS dictionary updates, and modifications to healthcare procedures.

• Rules Implementation and Verification: Validate Cotiviti and CXT rule changes, ensuring that new or modified rules are implemented correctly and produce the expected results across relevant claims scenarios.

• Healthcare Product and Contract Validation: Apply knowledge of healthcare products, member accounts, contracts, and benefit structures to ensure accurate claims processing across different configurations.

• Defect Identification and Resolution: Identify discrepancies, investigate unexpected test results, document defects, and collaborate with relevant stakeholders to support timely resolution and successful implementation.

• Quality Assurance and Compliance: Maintain thorough testing documentation and follow established quality management procedures to support system reliability, claims accuracy, and consistent operational standards.

Requirements

• Education: A bachelor's degree or equivalent graduate qualification in any discipline.

• Professional Experience: Approximately 3–6 years of relevant experience in software testing, quality assurance, healthcare claims management, or a related operational or technical role.

• Healthcare Claims Knowledge: Understanding of healthcare claims processing, including products, member accounts, contracts, and claims adjudication scenarios.

• Cotiviti Expertise: Knowledge of Cotiviti rules and triggers, including FRE, UNB, MUE, non-covered services, and bundled claim scenarios.

• Application Experience: Practical experience working with HealthRules Payor (HRP) and the Cotiviti tool is highly relevant to the role.

• Testing Methodologies: Experience preparing test plans and test cases and executing unit, functional, end-to-end, and regression testing.

• Rules and System Updates: Ability to analyse and validate application changes, including Cotiviti and CXT rule implementations and quarterly CMS dictionary updates.

• Analytical and Problem-Solving Skills: Strong attention to detail and the ability to investigate discrepancies, identify defects, analyse test results, and determine whether system behaviour meets expected requirements.

• Documentation Skills: Ability to maintain clear, accurate, and comprehensive test documentation, including test scenarios, execution results, and defect reports.

• Communication and Collaboration: Strong communication skills and the ability to work effectively with technical teams, business stakeholders, and quality assurance colleagues.

• Quality-Focused Mindset: A structured, methodical, and proactive approach to testing, with a commitment to accuracy, process consistency, and continuous improvement.

Benefits

• Opportunity to develop expertise in healthcare claims management, quality assurance, and healthcare technology platforms.

• Exposure to HealthRules Payor, Cotiviti, and healthcare claims validation processes.

• Opportunities to strengthen testing, analytical, and problem-solving skills in a specialised domain.

• Experience supporting system enhancements, regulatory updates, and claims processing quality initiatives.

• Opportunities for professional development and career progression in quality management and healthcare technology.

• Collaborative working environment with exposure to cross-functional testing and implementation activities.

How Jobgether works

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

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