Medical Tester - Cotiviti Tool /HRP -Medical Claims - 3 Years -Remote

Senior Executive Tester-HealthRules Payor(HRP) -Cotiviti Tool/CXT - Medical Claims- 3–5 Years -Remote

Are you an experienced US Healthcare Testing professional with hands-on expertise in HealthRules Payor (HRP), Cotiviti, and CXT? We are looking for a HealthRules Payor Senior Executive Tester to support end-to-end claims testing, validate Cotiviti rule implementations, and ensure seamless execution of Quarterly CMS updates. If you have a strong background in healthcare claims adjudication, HRP testing, and payment integrity solutions, this is an excellent opportunity to work remotely with a leading healthcare organization.

Location: PAN India (Work From Home)

Must Have - Cotiviti tool , CXT , HIPPA Regulations , HRP

Your Future Employer- Our client is a leading healthcare technology and digital transformation organization delivering innovative payer solutions to global healthcare insurers. The organization specializes in claims processing, payment integrity, healthcare analytics, and HealthRules Payor implementations while serving Fortune 500 healthcare clients across the US market.

Responsibilities

1. Perform end-to-end testing for HealthRules Payor (HRP) applications across multiple healthcare products and benefit plans.
2. Execute testing on Cotiviti edits, rules, triggers, and CXT implementations, ensuring accurate healthcare claim adjudication.
3. Validate claim scenarios involving FRE, UNB, MUE, Non-Covered Services, Bundled Scenarios, and other Cotiviti edits.
4. Create comprehensive Test Plans, Test Scenarios, Test Cases, and execute Functional, Unit, Regression, and System Testing.
5. Support testing for Quarterly CMS Dictionary Updates and validate changes before production deployment.
6. Analyze member accounts, provider contracts, healthcare benefits, pricing configurations, and claim processing workflows.
7. Identify, document, track, and resolve application defects while ensuring timely closure.
8. Collaborate with Business Analysts, Configurators, Developers, and QA teams for successful project execution.
9. Ensure compliance with HIPAA regulations, healthcare standards, and organizational quality processes.
10. Deliver high-quality testing within defined timelines while maintaining accuracy and process excellence.

Requirements

1. Graduate in any discipline.
2. 3–5 years of experience in the US Healthcare Payer domain.
3. Minimum 2 years of hands-on experience with HealthRules Payor (HRP).
4. Minimum 1 year of experience working with the Cotiviti Tool.
5. Strong knowledge of Cotiviti Rules & Triggers, including FRE, UNB, MUE, Bundled, and Non-Covered scenarios.
6. Hands-on experience in Healthcare Claims Testing and Claims Adjudication.
7. Working knowledge of CXT Tool.
8. Experience in Test Planning, Test Scenario Creation, Test Case Preparation, QA, Functional Testing, Regression Testing, and Test Runner Tools.
9. Good understanding of Quarterly CMS Dictionary Updates.
10. Strong knowledge of CPT, ICD-10, and HCPCS coding standards.
11. Understanding of HIPAA regulations and healthcare compliance.
12. Excellent analytical, communication, and stakeholder management skills.

What's in it for You?

• 100% Remote Work Opportunity (PAN India)
• Exposure to enterprise-level HealthRules Payor and Cotiviti implementations.
• Opportunity to work on high-impact US Healthcare payer projects.
• Collaborative work environment with strong career growth opportunities.
• Competitive compensation and long-term career progression.

Reach Us- If you believe you are the right fit for this opportunity, share your updated resume at parul.arora@crescendo-global.com

Disclaimer- Crescendo Global specializes in Senior to C-Level niche recruitment. We are passionate about connecting exceptional talent with leading organizations across industries.

Note: Due to the high volume of applications, only shortlisted candidates will be contacted.

Profile Keywords- HealthRules Payor | HRP | Cotiviti | CXT | US Healthcare | Healthcare Payer | Claims Testing | Claims Adjudication | QA Testing | Functional Testing | Regression Testing | Unit Testing | System Testing | Test Planning | Test Cases | Test Scenarios | Payment Integrity | Medicare | Commercial Claims | Provider Contracts | Benefit Configuration | CPT | ICD-10 | HCPCS | HIPAA | CMS Dictionary Updates | FRE | UNB | MUE | Healthcare Technology | Remote Jobs | Work From Home