IT Client Management
Quality Assurance Lead (Enrollment & Eligibility)
Chicago, IL, United States

It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Who You’ll Be Working With:

The Integration Quality (IQ) Department focuses on end to end (E2E) defect reduction. We test client implementations & major enhancements across each client’s ecosystem meeting workstream based success criteria. Our team engages other Evolent, Health Plan, and Partner Testing Teams to prepare capability under test for operational readiness. Our framework and tools are employed to identify areas of confidence & risk across technical & operational workflow before production. Our employees bring leadership and rigor to each testing effort reusing assets as much as possible & conducting business to the IQ standard for risk mitigation.

What You’ll Be Doing:

A domain represents a business area in the end to end healthcare ecosystem. Examples of domains include benefits, enrollment & billing, provider, reimbursement, utilization management, claims, mailroom, finance, customer service, portal, access to care, care management, outreach, fraud, quality, encounters, and reporting. Active domains under test require a subject matter expert to find the most valuable defects. The Domain Lead (DL) reports to a manager or the IQ Director. The DL provides an in depth understanding of the intricacies of the domain for the testing team activities including examples such as business & technical pre-requisites, inbound transactions, technical processing, operational processing, outbound transactions, fulfillment, and reporting. DLs write & maintain reusable test cases against requirements (called test assets) as well as lead domain-based test execution supported by workstream analysts. One or many domain leads may be engaged in any testing effort. The DL is:

  • the day to day point of contact and escalation representing IQ for assigned domain scope
  • responsible to escalate risks and issues in coordination with the delivery manager for status reporting
  • responsible to enforce department standards as directed by the delivery manager
  • consulted for test plan creation, maintenance, approval, & socialization (level set) by the delivery manager
  • responsible to build the test case suite for assigned domain scope in a timely manner including:
    • create new test cases linked to business and / or technical requirements or select existing test assets for execution to fortify regression testing
    • ensure test data required for test case execution is able to be acquired from engineering
    • walkthrough and improve the test case suite with workstream stakeholders
  • consulted for sequencing of end to end testing dependencies with the delivery manager as identified for use in the master schedule
  • consulted for staffing inventory creation, interdepartmental staffing requests, & upkeep of the staffing needs throughout the assigned testing effort (capacity model provided) by the delivery manager
  • consulted to set test case execution goals to support delivery manager productivity reporting
  • consulted to set test case capacity model execution parameters as required for assigned domain
  • responsible for the day to day operation of assigned testing team domain analysts and assignment of work for build, execution, and closure activities including but not limited to domain training, access needs, test execution, data needs, environment needs, defect entry, status reporting, confidence & risk reporting
  • responsible to execute test cases and record results for assigned domain scope during test execution
  • responsible to triage discrepancies, set defect priority & urgency, and enter defects found by domain team for assigned domain scope during test execution
  • consulted to manage and report risk, issues, and decisions with the delivery manager
  • responsible to attend and lead test team meetings requiring domain lead support for testing activities
  • responsible to escalate environment needs and outages to the deliver manager during execution
  • responsible to maintain assigned domain test assets on a frequent basis for assigned domain scope using the test management tool in collaboration with workstream analysts and change advisory board
  • assigned other duties as required

The Experience You’ll Need (Required):

  • BS or BA Degree
  • A minimum of 6 years formal quality assurance experience
  • A minimum of 6 years operations or testing experience (can overlap with quality assurance experience) in at least one domain such as benefits, enrollment & billing, provider, reimbursement, utilization management, claims, mailroom, finance, customer service, portal, access to care, care management, outreach, fraud, quality, encounters, and reporting
  • Demonstrable experience as the lead for at least 2 or more testers for at least one domain for a Medicaid, Waiver, Health Insurance Marketplace, Commercial, or Medicare healthcare implementation with an EPO, HMO, or PPO plan type for System Integration Testing or User Acceptance Testing team
  • Demonstrable experience operating testing activity for a domain under one mature SDLC (Software Development Life Cycle) with a leadership approved test plan (or test strategy)
  • Demonstrable experience operating at least one test management and defect management tool as a subject matter expert for a domain
  • Demonstrable experience creating and managing test assets with test data
  • Demonstrable experience with test environment management and releases for the domain
  • Demonstrable experience in verbal and written communication with domain teams and program leadership
  • Demonstrable experience working concurrent projects, activities, and tasks under time constraints
  • General knowledge of data flow and system landscape for the domain
  • General knowledge of EDI transactions for the domain
  • Working knowledge of applicable domain terminology & code set vocabulary such as DRG, CPT, HCPCS, ICD10 diagnosis & procedure, revenue codes, fee schedules, contracts, pricing
  • Working knowledge of Microsoft Word, Excel, and PowerPoint
  • Experience to deliver job responsibilities listed above


Eligibility & Enrollment specific testing experience:

  • Experience manipulating & processing 834 Enrollment files
  • Experience with enrollment testing – adds, changes, terms, retros
  • Experience with member match logic testing
  • Experience with PCP auto assignment logic testing
  • Experience with member portal testing


Finishing Touches (Preferred):

  • PROD Check Out & Model Office Experience
  • Confluence experience
  • Zephyr experience
  • JIRA experience


Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. 


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