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Role Purpose: 

Responsible for leading and executing the full testing lifecycle for all health insurance, digital, and NPHIES related technology initiatives. This role ensures that every system, integration, and transaction-spanning eligibility, claims, prior authorization, provider interactions, coding standards, and data exchange meets functional accuracy, performance, security, and regulatory compliance expectations. The Senior Manager oversees hands on test planning, test execution, defect management, automation development, non functional validation, and end to end quality assurance to guarantee reliable, compliant, and high performing solutions.

This role requires deep expertise in health insurance operations and NPHIES workflows, coupled with strong technical testing capabilities. The Senior Manager drives quality execution across manual testing, automation, performance testing, and data validation while embedding structured, repeatable testing practices across teams. Through rigorous test execution, continuous improvement, and strict adherence to health interoperability standards.

Key Accountabilities:

1-QA Planning & Execution:

• Develop test plans, test scenarios, and test scripts for all releases.

• Lead hands on execution of SIT, functional, system integration, and regression testing.

• Ensure readiness of test environments, test data, and entry/exit criteria.

• Manage defect triage, reporting, and closure.

2-Health Insurance & NPHIES Testing:

• Conduct hands on testing for eligibility, claims, prior authorization, membership, benefits, provider network, and policy modules.

• Execute testing for NPHIES transactions: Eligibility, eClaims, eAuthorizations, Clinical Coding, Payments, and Attachments.

• Validate business rules, product configurations, and actuarial logic.

• Execute end-to-end process testing across TPA and insurance systems.

• Ensure compliance with NHIC, CCHI, NPHIES standards.

• Conduct interoperability and integration testing with external stakeholders.

• Validate coding standards: ICD 10 AM, DRG etc.

3-Test Automation Execution:

• Develop automated test scripts for UI, API, and NPHIES flows.

• Execute automated regression cycles and maintain automation suites.

• Integrate automation into CI/CD pipelines for continuous testing.

4-Non Functional Testing:

• Conduct load, stress and volume tests for insurance and NPHIES APIs.

• Validate API performance and stability under peak loads.

• Execute basic security testing (vulnerabilities, access validation, API security).

5-Reporting & Metrics:

• Prepare daily/weekly test reports, dashboards, and traceability matrices.

• Publish quality status, defect summaries, and readiness reports to stakeholders.

• Ensure test documentation, evidence, and audit trails are maintained.

•  Extensive hands on experience in functional, integration, regression, UAT, E2E testing

• Strong domain expertise in health insurance, covering:

• Eligibility

• Claims (Submission, Adjudication, Rejection workflows)

• Prior Authorization

• Provider Network

• Membership & Benefits

• Proven experience executing NPHIES testing (Eligibility, eClaims, eAuthorizations, Clinical Coding transactions)

• Hands on validation of coding standards: ICD 10 AM,

• Strong experience in API testing using Postman, SoapUI

• Experience executing automation testing (UI/API/Mobile App)

• Experience conducting performance, load, and volume testing

• Strong stakeholder management and cross functional coordination skills

• Excellent defect management, test documentation, and reporting capabilities

• Ability to interpret regulatory requirements from NPHIES, NHIC, and CCHI

• Strong analytical, troubleshooting, and problem solving skills

• Ability to work in fast paced environments with strict deadlines

o Bachelor’s degree in Computer Science, Software Engineering, Information Technology, or related fi