Role Title: Sr. Manager – Testing and Quality

Role Purpose:

The Senior Manager – Testing & Quality is responsible for leading and executing the full testing lifecycle for all health insurance, digital, and NPHIES‑related technology initiatives. This role ensures that every system, integration, and transaction—spanning eligibility, claims, prior authorization, provider interactions, coding standards, and data exchange meets functional accuracy, performance, security, and regulatory compliance expectations. The Senior Manager oversees hands‑on test planning, test execution, defect management, automation development, non‑functional validation, and end‑to‑end quality assurance to guarantee reliable, compliant, and high‑performing solutions.

This role requires deep expertise in health insurance operations and NPHIES workflows, coupled with strong technical testing capabilities. The Senior Manager drives quality execution across manual testing, automation, performance testing, and data validation while embedding structured, repeatable testing practices across teams. Through rigorous test execution, continuous improvement, and strict adherence to health interoperability standards.

ACCOUNTABILITIES_SHOULD BE A MAXIMUM OF 6 ACCOUNTABILITIES)

1. QA Planning & Execution:

Key Task:

· Develop test plans, test scenarios, and test scripts for all releases.

· Lead hands‑on execution of SIT, functional, system integration, and regression testing.

· Ensure readiness of test environments, test data, and entry/exit criteria.

· Manage defect triage, reporting, and closure.

· Complete, accurate, and approved test plans.

· High-quality testing cycles delivered on schedule.

· Defects identified early with clear traceability.

Key Deliverables

· Complete, accurate, and approved test plans.

· High-quality testing cycles delivered on schedule.

· Defects identified early with clear traceability.

2. Health Insurance & NPHIES Testing

Key Task:

• Conduct hands on testing for eligibility, claims, prior authorization, membership, benefits, provider network, and policy modules.

• Execute testing for NPHIES transactions: Eligibility, eClaims, eAuthorizations, Clinical Coding, Payments, and Attachments.

• Validate business rules, product configurations, and actuarial logic.

• Execute end-to-end process testing across TPA and insurance systems.

• Ensure compliance with NHIC, CCHI, NPHIES standards.

• Conduct interoperability and integration testing with external stakeholders.

• Validate coding standards: ICD 10 AM, DRG etc

Key Deliverables:

• Fully verified insurance workflows.

• NPHIES-compliant transactions.

• Accurate claims and eligibility outcomes.

• Zero major issues in production.

3. Test Automation Execution

Key Task:

• Develop automated test scripts for UI, API, and NPHIES flows.

• Execute automated regression cycles and maintain automation suites.

• Integrate automation into CI/CD pipelines for continuous testing.

Key Deliverables:

• Automated regression Suites.

• Faster release cycles with less manual effort.

• Increased test coverage and reduced defect leakage.

4. Non-Functional Tesst

Key Task:

• Conduct load, stress and volume tests for insurance and NPHIES APIs.

• Validate API performance and stability under peak loads.

• Execute basic security testing (vulnerabilities, access validation, API security).

Key Deliverables:

· Performance baselines validated.

· High system stability under peak demand.

· Zero critical performance/security issues pre go-live.

5. Reporting and Metrics.

Key Task:

• Prepare daily/weekly test reports, dashboards, and traceability matrices.

• Publish quality status, defect summaries, and readiness reports to stakeholders.

• Ensure test documentation, evidence, and audit trails are maintained.

Key Deliverables:

· Transparent QA dashboards.

· Clear go/no-go decisions.

· Complete documentation for compliance and audits.

MAIN CONTACTS – (DEFINES EXTERNAL WORKING RELATIONSHIPS / INTERACTION FREQUENCY)

§ Business Units and Internal Departments | Nature of Job

§ Executive and Senior Management | Nature of Job

§ Partners, Suppliers, Vendors | Nature of Job

EXPERIENCE - (MINIMUM KNOWLEDGE TO PERFORM THE JOB EFFECTIVELY)

· 8–10 years of experience

· Extensive hands‑on experience in functional, integration, regression, UAT, E2E testing

· Strong domain expertise in health insurance, covering:

· Eligibility

· Claims (Submission, Adjudication, Rejection workflows)

· Prior Authorization

· Provider Network

· Membership & Benefits

· Proven experience executing NPHIES testing (Eligibility, eClaims, eAuthorizations, Clinical Coding transactions)

· Hands‑on validation of coding standards: ICD‑10‑AM,

· Strong experience in API testing using Postman, SoapUI

· Experience executing automation testing (UI/API/Mobile App)

· Experience conducting performance, load, and volume testing

· Strong stakeholder management and cross‑functional coordination skills

· Excellent defect management, test documentation, and reporting capabilities

· Ability to interpret regulatory requirements from NPHIES, NHIC, and CCHI

· Strong analytical, troubleshooting, and problem‑solving skills

· Ability to work in fast‑paced environments with strict deadlines

Other Requirement:

Required:

· Test Management Tools:

o Azure DevOps, JIRA, TFS

· API Testing Tools:

o Postman, SoapUI

· Automation Tools / Frameworks:

o Selenium, Playwright, RestAssured,Python

· Performance Testing:

o JMeter, LoadRunner

· Data & SQL:

o Strong SQL for backend validation and data reconciliation

· Knowledge of health standards & integrations:

o HL7 / FHIR (basic understanding)

o EDI formats (NPHIES JSON schemas, X12-style structures)

· Experience with test documentation:

o RTM, Test Plans, Test Scenarios, Test Reports, Audit Evidence

Bachelor’s degree in Computer Science, Software Engineering, Information Technology, or related field.

o Professional certifications highly desirable:

o ISTQB Foundation/Advanced Level (Test Analyst)

o Certified Software Quality Analyst (CSQA)

o API Testing or Postman Certifications

o Performance Testing certifications (JMeter, LoadRunner, etc.)

o Health insurance domain certifications (preferred)

Document Control Specialist

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