Test Lead - Manual Testing, US Healthcare and Medicaid Pharmacy

Role Overview Gainwell Technologies is seeking an experienced Test Lead specializing in Manual Testing within the US Healthcare and Medicaid Pharmacy domain. This is a remote-friendly opportunity where you will be part of a forward-thinking healthcare technology organization dedicated to delivering impactful health and human services solutions. This role is strictly limited to application testing and does not involve access to Protected Health Information or Personally Identifiable Information. Key Responsibilities - Perform comprehensive testing, troubleshooting, and analysis of application software for complex healthcare technology projects - Design, develop, implement, and maintain critical test processes and frameworks - Gather and interpret business requirements to develop executable test cases and distribute workload effectively across a team of test engineers - Coordinate with cross-functional stakeholders to analyze requirements, identify defect-causing issues, and communicate findings to the appropriate teams - Assist in drafting proposals to recommend improvements to existing testing processes and programs - Prepare accurate effort estimates for activities outlined in the test plan Required Qualifications - 15 or more years of overall experience with at least 5 years specifically in Medicaid pharmacy operations, MMIS or MES systems, PBM functions, or pharmacy claims processing - Strong understanding of NDC codes, HCPCS, quantity limits, and drug pricing methodologies - In-depth knowledge of Medicaid Preferred Drug Lists, clinical Prior Authorization criteria, and Drug Utilization Review requirements - Solid grasp of pharmacy benefit administration and reimbursement models - Hands-on experience with EDI transactions including 837, 835, and 278 formats - Proficiency with test management tools and SQL for data validation - Familiarity with platforms such as Gainwell, Conduent, Optum, Magellan, or similar Medicaid pharmacy modules Why Join Us At Gainwell Technologies, you will have the opportunity to contribute to meaningful healthcare outcomes while advancing your professional career through outstanding learning and development programs. Join a team that values innovation, collaboration, and making a real difference in communities across the United States.

- 15 plus years of overall IT testing experience - Minimum 5 years in Medicaid pharmacy operations or MMIS or MES systems - Knowledge of NDC, HCPCS, quantity limits, and drug pricing methodologies - Understanding of Medicaid PDL, clinical PA criteria, and DUR requirements - Experience in pharmacy benefit administration and reimbursement models - Hands-on experience with EDI transactions including 837, 835, and 278 - Proficiency in SQL for data validation - Experience with test management tools - Familiarity with Gainwell, Conduent, Optum, Magellan, or other Medicaid pharmacy platforms

- Remote work opportunity - Professional growth and development programs - Exposure to US Healthcare and Medicaid domain - Collaborative and innovative work environment