Description

Possesses strong experience in Clinical Adjudication (CAM), supporting medical necessity reviews, authorization workflows, and clinical policy validations, with solid alignment to payer decision frameworks.
Demonstrates strong understanding of utilization management and coding guidelines, enabling effective collaboration with clinical and business stakeholders.
Lead QA strategy for large-scale platform transformation (Broadcom ? IBM stack), ensuring seamless transition across systems.
Strong expertise in data migration validation, including before/after reconciliation and comprehensive regression coverage.
Hands-on experience with sampling-based validation approaches for large enterprise datasets and systems.
Proficient in automation-led validation, leveraging SQL/data checks and RPA/UI tools (e.g., UiPath) to drive efficiency.
Ability to define QA operating model, team structure, and delivery roadmap (8–15 resources) aligned to program goals.
Extensive exposure to enterprise-scale programs with multi-system dependencies (online, batch, and data migration ecosystems)

Key Skills

Education

Any Gradute