Experienced Test Manager – PBM
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Job Description
Experienced Test Manager leading PBM and Medicaid pharmacy testing for Gainwell Technologies’ healthcare technology solutions. Governing NCPDP transactions, claims validation, defects, and compliance delivery.
Responsibilities:
- Lead end-to-end pharmacy testing across SIT, UAT, Regression, and Parallel Testing for F6 transaction formats
- Develop and manage test strategy, plans, schedules, and execution governance
- Ensure alignment with compliance timelines and state Medicaid regulations
- Validate and enforce NCPDP F6 transaction routing, data crosswalks, expanded product identifiers, and telephony compliance
- Support the D.0 to F6 transition across 271 Eligibility Response and Formulary and Benefit outbound extracts
- Oversee pharmacy functional validation, including claims adjudication, drug pricing, formulary management, prior authorization, DUR, COB, rebates, and pharmacy financial reconciliation
- Manage defects and cross-functional coordination among business SMEs, PBMs, switch networks, vendors, developers, conversion teams, and onshore/offshore testing resources
- Provide leadership reporting and sponsor-facing stakeholder communication by tracking quality metrics, risks, issues, and test progress
Requirements:
- 10+ years of software testing experience
- 5+ years of Test Management experience
- Strong PBM or Medicaid pharmacy experience
- Direct exposure to NCPDP standards transitions (D.0, F2, or F6)
- Experience with large-scale DDI or MMIS modernization programs
- Expertise in claims adjudication, NCPDP transactions, Prior Authorization, Formulary management, Drug Rebate processing, Eligibility (270/271) processing, and pharmacy financial validation
- Experience using ALM/JIRA and SQL for data validation
- Strong leadership, communication, and stakeholder management skills
- Fully remote work limited to Contiguous US locations
- Video cameras required during all interviews and the initial week of orientation
Benefits:
- Work flexibility
- Learning and career development
- Flexible vacation policy
- 401(k) employer match
- Comprehensive health benefits
- Educational assistance
- Leadership and technical development academies
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