Lead Quality Assurance Analyst

Position: Lead Vendor Quality Assurance Analyst

Practice: Health and Welfare Operations

Job Title: Lead Vendor Quality Assurance Analyst ( Carrier Operations)

Reporting To: QA Manager

Experience: 5+ Years

Job Overview:

The Lead Vendor Quality Assurance Analyst (Carrier Operations) is responsible for overseeing carrier file quality assurance activities within the delivery of health and welfare benefits administration. The role combines hands-on domain expertise with team leadership, ensuring that carrier flat files, including ANSI and HIPAA 834 files, are validated accurately, consistently, and in compliance with carrier requirements before transmission.

The Lead serves as the primary quality owner for carrier operations, managing analysts, driving defect reduction initiatives, and ensuring operational readiness in production-adjacent environments where accuracy and timeliness are critical.

Key Responsibilities and Duties

• Lead and manage a team of carrier QA analysts responsible for validating flat files and 834 files prior to transmission.
• Oversee the translation of carrier file requirements into structured test plans, scenarios, and validation frameworks.
• Review and approve file validation results to ensure structural accuracy, format compliance, and data integrity before release.
• Provide technical guidance on complex eligibility scenarios, reconciliation issues, and carrier-specific requirements.
• Ensure comprehensive end-to-end data reconciliation from upstream imports through system outputs to final carrier file delivery.
• Review carrier rejection reports and post-transmission feedback, identify trends, and implement preventive controls to reduce future defects.
• Monitor quality metrics, defect trends, and SLA adherence, and drive corrective and preventive actions to improve delivery stability.
• Ensure proper documentation standards across test plans, validation evidence, defect logs, and carrier onboarding artifacts.
• Act as the primary escalation point for carrier-related issues and coordinate cross-functional efforts to resolve them.
• Apply strong health and welfare domain knowledge, including eligibility and enrollment processing rules, to ensure accurate interpretation of file requirements and testing outcomes.
• Continuously enhance testing effectiveness by adopting improved methods, tools, and quality controls appropriate for regulated benefits administration environments.

Required Qualifications

• Bachelors degree in Computer Science or equivalent technical education.
• 5+ years of experience in health insurance or health and welfare benefits administration, with strong exposure to carrier operations workflows.
• Prior experience leading or managing QA or operational delivery teams.
• Strong hands-on experience testing flat files (delimited or fixed-width) and HIPAA 834 files in regulated environments.
• Strong understanding of ANSI/834 file structures, data validation principles, and carrier integration requirements.
• Proficiency in SQL and relational database concepts to oversee reconciliation and defect analysis.
• Experience reviewing and improving QA documentation standards and defect management processes.
• Strong analytical, problem-solving, and communication skills.
• Experience working in production-oriented environments with a low tolerance for error.
• Familiarity with Agile or structured delivery environments.
• Experience managing carrier onboarding or file certification cycles.
• Exposure to automation or process improvement initiatives within QA environments.