Benefit Confirmation Lead position

Location: Pune, India

Job Requirements . Team Lead – QA / US Healthcare (Benefit Configuration)
Experience: 10+ Years Position Overview We are seeking an experienced Team Lead – QA / US Healthcare with strong expertise in Benefit Configuration, Eligibility, Member Loads, Accumulator Processing, and Claims/Benefits Validation . The ideal candidate will lead QA activities across QA/TEST/PROD environments , provide technical and functional guidance to the team, drive defect and incident resolution, and ensure high-quality delivery aligned with client requirements and US Healthcare business rules. The role requires a hands-on leader who can manage day-to-day QA activities while collaborating closely with Business, Benefit Configuration, Development, Production Support, and client stakeholders. Key Responsibilities Lead and mentor a team of QA Analysts/Engineers supporting US Healthcare benefit configuration and related applications. Own QA planning, execution, tracking, and delivery for benefit configuration, eligibility, claims, and member-related initiatives. Review and validate benefit configurations across QA/TEST/PROD environments to ensure alignment with plan documents, business rules, and client requirements. Validate member eligibility files and member loads; troubleshoot load failures, data exceptions, and downstream processing issues. Validate accumulator processing and reconciliation to ensure accurate benefit utilization and financial calculations. Develop and review test strategies, test scenarios, test cases, and execution plans for system, integration, regression, UAT, and mid-cycle changes. Drive defect management from identification through root cause analysis, resolution, retesting, and closure. Lead cross-functional triage across QA, TEST, PROD, Development, Benefit Configuration, and Business teams to resolve critical issues. Perform root cause analysis for production incidents and recurring defects and drive preventive/corrective actions. Review requirements, benefit summaries, specifications, and plan documents and translate them into effective configuration and testing conditions. Ensure comprehensive validation of benefit configurations, eligibility rules, coverage levels, pricing calculations, and system outputs. Monitor QA deliverables, timelines, risks, dependencies, and resource allocation to ensure successful project delivery. Provide regular status updates to stakeholders, highlighting progress, risks, issues, dependencies, and mitigation plans. Establish and enforce QA standards, processes, documentation, and best practices across the team. Identify opportunities for process improvements, test automation, and increased QA efficiency. Support client discussions, requirement clarifications, demonstrations, and issue-resolution meetings as required. Act as a subject matter expert for US Healthcare Benefits Configuration and QA/Testing . Required Qualifications 10+ years of experience in US Healthcare IT , preferably with payer, TPA, or health insurance experience. Proven experience leading QA teams and managing end-to-end QA delivery. Strong hands-on experience with US Healthcare Benefit Configuration and validation of plan rules, eligibility criteria, coverage levels, and benefit structures. Experience with Facets , including Benefit Configuration, Claims Processing, and Member Benefits Validation. Strong understanding of eligibility processing, member loads, accumulator processing, claims processing, and reconciliation . Experience developing and executing manual and automated test cases for healthcare applications. Strong experience in functional, integration, regression, UAT, and production validation testing. Proven experience in defect management, incident management, root cause analysis, and cross-functional issue triage. Strong leadership, mentoring, communication, stakeholder management, and problem-solving skills. Ability to manage multiple priorities, drive deliverables, and work effectively in a fast-paced environment. Strong ability to communicate complex healthcare and technical issues clearly to both technical and business stakeholders. Tools & Technologies Facets – Benefit Configuration, Claims Processing, Member Benefits Validation Azure DevOps (ADO) – Test Case Management, Defect Tracking, Sprint Planning, Reporting VBA – Data analysis, validation, and test support QA/Test Management and Defect Management tools Domain Expertise US Healthcare / Health Insurance Benefit Configuration Claims Processing Eligibility & Member Loads Accumulator Processing & Reconciliation Benefit Testing & Audit Validation Defect & Incident Management Root Cause Analysis Functional, Integration, Regression & UAT Testing QA/TEST/PROD Environment Management Leadership Responsibilities Lead, mentor, and guide QA team members and support their technical and domain development. Conduct task allocation, progress tracking, and quality reviews. Establish QA priorities based on business impact, release timelines, and production risks. Drive collaboration between QA, Development, Business, Configuration, and Production Support teams. Review team deliverables and ensure adherence to quality standards and processes. Escalate critical risks and issues proactively and drive them toward resolution. Contribute to hiring, onboarding, training, and performance development of QA team members. Education Bachelor’s degree or equivalent experience in Computer Science, Information Systems, Engineering, or a related field .