Adjudication, Automation, CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing), Clinical Validation, Data Migration, Data Quality, Data Sets, Ecosystems, Healthcare, IBM Product Family, Medical Coding, Patient Care Authorizations, Quality Assurance, Reconciliation, SQL (Structured Query Language), Testing, User Interface Tools, Utilization Management
Work Location: Hartford CT 6156
Contract duration: 12 months
Interview Mode- In-person Interview
Job Details:
Must Have Skills- QA Strategy & Transformation (Broadcom ? IBM migration)
- Data migration validation (reconciliation & regression)
- Sampling-based validation for large datasets
- Automation-led validation approaches
- SQL / data validation techniques
Nice to have skills
Clinical Adjudication (CAM)
Medical necessity review processes
Authorization workflows
Clinical policy validation
Payer decision frameworks
Detailed Job Description
" Possesses strong experience in Clinical Adjudication (CAM), supporting medical necessity reviews, authorization workflows, and clinical policy validations, with solid alignment to payer decision frameworks.
" Demonstrates strong understanding of utilization management and coding guidelines, enabling effective collaboration with clinical and business stakeholders.
" Lead QA strategy for large-scale platform transformation (Broadcom ? IBM stack), ensuring seamless transition across systems.
" Strong expertise in data migration validation, including before/after reconciliation and comprehensive regression coverage.
" Hands-on experience with sampling-based validation approaches for large enterprise datasets and systems.
" Proficient in automation-led validation, leveraging SQL/data checks and RPA/UI tools (e.g., UiPath) to drive efficiency.
" Ability to define QA operating model, team structure, and delivery roadmap (8 15 resources) aligned to program goals.
" Extensive exposure to enterprise-scale programs with multi-system dependencies (online, batch, and data migration ecosystems).
Minimum years of experience----8-10 years
Certifications Needed :No
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