PBM Tester (NCPDP D.0 to F6 implementation) :: Remote

About the role

We're looking for a Test Engineer with strong pharmacy claims and PBM testing experience to support an NCPDP D.0 to F6 implementation.

Responsibilities

• Validate transaction changes, claim adjudication outcomes, eligibility and coordination of benefits scenarios, reject messaging, payer sheet impacts, data mapping, regression coverage, and production readiness.
• Analyse NCPDP D.0 and F6 implementation requirements, payer sheets, field mapping documents, business rules, and transaction specifications to identify test scenarios and validation needs.
• Create and maintain test plans, test scenarios, test cases, test scripts, test data, and traceability for pharmacy claim transaction testing.
• Analyse requirements, coordinate with BAs / Subject Matter Experts.
• Validate NCPDP pharmacy claim request and response transactions, including claim submission, reversal, eligibility, coordination of benefits, reject codes, messaging, pricing, accumulators, and coverage determination scenarios.
• Perform functional, regression, integration, end-to-end, batch, database, API/interface, UAT support, Parallel and production validation testing for D.0 to F6 changes.
• Develop and execute SQL queries to validate claims data, member eligibility, benefit setup, pricing, accumulators, drug data, payer configuration, and downstream reporting impacts.
• Compare D.0 and F6 transaction behaviour to confirm that new, modified, and retired fields are processed correctly across impacted systems.
• Identify, document, track, retest, and close defects using approved defect management processes and tools.
• Support test data creation for positive, negative scenarios.
• Coordinate testing dependencies with PBM SMEs, business users, developers, PBM teams, and downstream application teams.
• Coordinate Onshore / Offshore as needed.
• Apply working knowledge on AI tools for automation.
• Prepare daily or weekly status updates, defect reports, test execution metrics, test coverage summaries, and implementation risk updates.
• Participate in requirement reviews, design walkthroughs, payer sheet reviews, field mapping reviews, release readiness meetings, and implementation checkpoints.

Requirements

• NCPDP D.0
• NCPDP F6
• PBM/pharmacy claims
• SQL
• SIT
• UAT
• Parallel testing
• Regression testing
• Trading partner testing
• Release testing
• Production validation
• Post‑implementation defect triage
• Strong pharmacy claims testing experience
• Working knowledge of NCPDP D.0 and ability to learn and validate F6 changes
• Strong SQL and data validation skills
• Experience collaborating with PBM SMEs, BAs, development, and business teams