Overview About HealthEdge HealthEdge® is trusted to provide the technology and services that power health plans’ most important value streams. With an integrated platform of solutions spanning claims administration, quality improvement, prospective payment accuracy, provider network management, care management, member engagement and risk adjustment, HealthEdge enables health plans to converge their data so they can harness automation and the promise of AI. Combining this next-gen technology with services and expertise gives health plans unmatched capabilities to deliver a future of frictionless and cost-effective healthcare experiences. For more information, visit www.HealthEdge.com. Position Overview: We are searching for a highly skilled and experienced Senior QA Lead to join our growing team. The Senior QA Lead will help in identifying the testing strategy and testing needs to implement UST HealthProof’s core-admin ecosystem for our Health plan customers. The QA lead will work directly with the Health Plan Customers, Business analysts, Internal development and product teams and other SMEs to define the scope of QA testing right for data conversion, configuration, and Integration. Candidate should have deep experience in HealthCare Payor domain especially with integrating Core admin platforms (Claims adjudication, enrollment, provider platforms) and excellent technical and communication skills and ability to engage as part of a team working both physically together and virtually. Your Impact: - Responsible for developing Testing plan for the core implementation including conversion, Configuration, and Integration activities for the Health Rules Payor implementation. - Responsible for definition, planning and execution of testing efforts. - Test lead should also be responsible for Test Data management activities including Test plan documentation, strategy design, Test case preparation, Test data identification and Execution plan. - As a lead participate all design level activities and accuracy review meetings and project the points from testing standard. - Designs and administers more complex portions of the testing process by understanding the core line of business need. - Should be responsible for test results, presenting test results to customers and leadership to ensure implementation meets the quality of customer expectations. - Should be responsible for maintaining the repository of testing results and execution status during the implementation phase. - Test lead should be capable of analyzing complex systems requirements and helps in identifying root cause of the issue if it is reported on the core system implementation. - Also responsible for identifying and documenting technical, systems and performance related defects and assists in providing solutions to resolve defects. - Test lead should assist in preparing time estimates and justification for assigned tasks. - As a Test lead be responsible for the maintaining testing timeline and delivery plan effectively within the given time by adhering the quality standards. - As a QA lead, need to participate in planned meetings such as daily stand up, sprint planning and retrospective, release go, no-go meetings and present the QA point of facts. - Develops comprehensive Test related documentation for all testing activities happening within the implementation. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. What You Bring: - Bachelor’s degree or higher in a related field - 12+ years of relevant work experience in technology integrations - 10+ years of work experience in QA leadership roles - Experience in Test data management including Test plan and Test strategy documentation - Experience in planning and time management skills for meeting project goal and implementation on time - Solid experience of the healthcare industry is preferred - Basic Data base knowledge is preferable. Application experience or similar related training; focusing on data analysis and/or data processing - Experience with Healthcare domain - Exposure to test management tools like Jira, Test rail etc. - Exposure to Test automation tools - Experience working in an onshore/offshore model is a must - Experience working HealthEdge applications like HealthRules Payor or GuidingCare is a plus - Commitment to Customer and quality - Communication skills with peers, customers, and partners including the ability to convey information effectively and efficiently - Thrives in a dynamic, sometimes ambiguous environment and has a knack for quickly prioritizing needs and creating scalable processes and structure - Comfortable in a fully remote environment that relies heavily on asynchronous written collaboration and communication HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace. We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers. Geographic Responsibility: While HealthEdge is located in Boston, MA you may live anywhere in the USType of Employment: Full-time, permanent Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job: - The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus. - Work across multiple time zones in a hybrid or remote work environment. - Long periods of time sitting and/or standing in front of a computer using video technology. - May require travel dependent on company needs. The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check. HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. #LI-Remote **The annual US base salary range for this position is $100,000 to $120,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at HMS, a Gainwell Company carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities. Summary The Customer Experience Quality Assurance Analyst is responsible for monitoring and evaluating the quality across call center and back-office transactional operations. This role supports our commitment to delivering exceptional, accurate, and compliant work through measurement, analysis, and review of calls, transactions, and related business processes. Responsibilities include conducting daily quality assurance reviews and audits to ensure adherence to Account and Company standards, policies and procedures. You may contribute to planning, execution, and delivery of quality initiatives. By partnering with centralized and account teams, your work will enhance employee, member, and client experiences to help achieve organizational goals. Your role in our mission - Evaluate customer interactions (calls, emails, chat, and back-office transactions), including complex cases, for compliance with quality standards and regulatory requirements. - Participate in and occasionally lead calibration sessions to ensure consistency in evaluations. - Share insights and align with stakeholders through regular engagement sessions. - Escalate unresolved issues, including negative customer experiences, to appropriate levels. - Analyze quality observations from both call center and back-office processes to identify trends and improvement opportunities. - Recommend process and policy enhancements based on data-driven insights. - Utilize procedural and technology automation to improve QA efficiency and effectiveness. - Remain current with industry best practices for contact center and back-office quality assurance. What we're looking for - Bachelor's degree or equivalent combination of education and experience. - Two or more years of quality assurance, including QA principles and methodologies, or subject matter expertise of area to be evaluated. - Demonstrated knowledge of Provider Enrollment and experience collaborating with operations teams across multiple areas. - Proficiency in Microsoft Office Suite and Sharepoint, with familiarity in contact center and back-office quality platforms (CXOne, Verint, etc.). - Strong written and verbal communication skills and ability to work effectively with diverse teams. What you should expect in this role - Strong organizational and time management skills. - Skilled at working independently and collaboratively. - Demonstrated adaptability to change and continuous improvement. The pay range for this position is $43,100.00 - $61,600.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at HMS, a Gainwell Company. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with HMS, a Gainwell Company, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about HMS, A Gainwell Technologies Company at our company website and visit our Careers site for all available job role openings. HMS, a Gainwell Company, is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. HMS defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

Job DetailsJob Location: Norwood, MA 02062Position Type: Full TimeSalary Range: $30.00 - $31.25 HourlyTravel Percentage: NoneCraving a New Adventure? Flex Your Clinical Skills Right from Your Couch! Are you a Registered Nurse (RN) seeking a role that challenges you, helps you grow, and lets you work from the comfort of your own home? MES has the perfect opportunity for you! We’re looking for a Clinical Quality Assurance Coordinator to join our team! In this role, you’ll be responsible for ensuring that Peer Review case reports meet the highest standards of quality, integrity, and compliance with client agreements, regulatory guidelines, and federal/state mandates. Why This Role Rocks: 100% Remote – Enjoy the flexibility of working from home! Impactful Work – You’ll play a key role in ensuring the quality and compliance of critical reports. Pick a Schedule That Works for You – Monday through Friday with rotating weekend shifts. You can start your day anytime between 7:00am-9:00am and end between 3:30pm-5:30pm EST with 1 late night per week from 12:00pm-8:30pm EST. Responsibilities include: Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews. Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations. Ensure that all client instructions and specifications have been followed and that all questions have been addressed. Ensure each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications. Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards. Ensure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates and is documented accurately on the case report. Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists. Ensure the provider credentials and signature are adhered to the final report. Identify any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed. Assist in resolution of client complaints and quality assurance issues as needed. Ensure all federal ERISA and state mandates are adhered to at all times. Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications. Promote effective and efficient utilization of company resources. Participate in various educational and or training activities as required. Perform other duties as assigned. If you’re a motivated, energetic RN ready to take on an exciting new challenge, we want you on our team! At MES, we offer a dynamic environment where your skills will shine. QualificationsHigh school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability. Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values. Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages. Must be a qualified typist with a minimum of 40 W.P.M Must be able to operate a general computer, fax, copier, scanner, and telephone. Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. Must possess excellent skills in English usage, grammar, punctuation and style. Ability to follow instructions and respond to upper managements’ directions accurately. Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met. Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed. Must be able to work independently, prioritize work activities and use time efficiently. Must be able to maintain confidentiality. MES Solutions is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance. MES offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k. Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

Job DetailsJob Location: Norwood, MA 02062Position Type: Full TimeSalary Range: $30.00 - $31.25 HourlyTravel Percentage: NoneCraving a New Adventure? Flex Your Clinical Skills Right from Your Couch! Are you a Registered Nurse (RN) seeking a role that challenges you, helps you grow, and lets you work from the comfort of your own home? MES has the perfect opportunity for you! We’re looking for a Clinical Quality Assurance Coordinator to join our team! In this role, you’ll be responsible for ensuring that Peer Review case reports meet the highest standards of quality, integrity, and compliance with client agreements, regulatory guidelines, and federal/state mandates. Why This Role Rocks: 100% Remote – Enjoy the flexibility of working from home! Impactful Work – You’ll play a key role in ensuring the quality and compliance of critical reports. Pick a Schedule That Works for You – Monday through Friday with rotating weekend shifts. You can start your day anytime between 7:00am-9:00am and end between 3:30pm-5:30pm EST with 1 late night per week from 12:00pm-8:30pm EST. Responsibilities include: Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews. Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations. Ensure that all client instructions and specifications have been followed and that all questions have been addressed. Ensure each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications. Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards. Ensure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates and is documented accurately on the case report. Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists. Ensure the provider credentials and signature are adhered to the final report. Identify any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed. Assist in resolution of client complaints and quality assurance issues as needed. Ensure all federal ERISA and state mandates are adhered to at all times. Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications. Promote effective and efficient utilization of company resources. Participate in various educational and or training activities as required. Perform other duties as assigned. If you’re a motivated, energetic RN ready to take on an exciting new challenge, we want you on our team! At MES, we offer a dynamic environment where your skills will shine. QualificationsHigh school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability. Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values. Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages. Must be a qualified typist with a minimum of 40 W.P.M Must be able to operate a general computer, fax, copier, scanner, and telephone. Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. Must possess excellent skills in English usage, grammar, punctuation and style. Ability to follow instructions and respond to upper managements’ directions accurately. Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met. Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed. Must be able to work independently, prioritize work activities and use time efficiently. Must be able to maintain confidentiality. MES Solutions is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance. MES offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k. Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.