The RX Claim system is used Adjudicate electronic claims for retail and mail pharmacies, Adjudicate manually-submitted claims. RX Claim system also used to Provide drug coverage information, Provide messages returning to pharmacy explaining next step of process of rejected claim, Determine if an accumulation, deductible (DED), maximum allowable benefit (MAB), or out-of-pocket (OOP) and the amount applied, Make change to plan parameters, per the client's request, Research claim and the reasoning behind the system's response
- Worked on multiple projects at the same time with proven track record testing, implementing and re-engineering RX Claim Adjudication application.
- Lead onsite/offshore teams assigning modules reviewing status everyday with the team and sending status report to business manager and project manager.
- Prepare project estimations/allocations, test plans, test cases, and test scenarios by using BRD and functional requirement documents. Performed functional, white box, black box, regression and integration testing.
- Involved all phases of software development lifecycle and followed Agile development methodologies
- Used Quality Center, for bug tracking, generated defect reports, and reviewing with the development team to run the QA phase smoothly, Research QC user requests (i.e.: workflow, customization and functionality on Admin)
- Setup and configuration of the overall Quality Center technical and operating environment in a Windows and SQL Server.