Qa Tmo Lead

Description:

The QA TMO Lead/Program Lead/Director for a healthcare payer organization is responsible for overseeing the Test Management Office (TMO) to ensure centralized governance of QA practices, regulatory compliance (HIPAA, CMS, NCQA), and quality improvement across multiple healthcare payer systems including EDI, claims, benefits, and portals. This leadership role acts as a liaison among QA teams, business stakeholders, IT departments, and compliance officers.

Key Responsibilities:

• Develop and govern enterprise QA strategies, processes, and policies tailored for healthcare payer systems.

• Manage prioritization and intake of QA demands spanning claims, enrollment, billing, provider systems, and digital front-ends.

• Oversee planning, compliance of test data, and execution for HIPAA-regulated scenarios.

• Define and monitor QA metrics such as defect leakage, coverage, test execution SLAs, and adherence to compliance.

• Lead a cross-functional QA team including analysts, automation engineers, and reporting specialists.

• Ensure validation of EDI transactions (837, 835, 834, 270/271) and readiness of test environments.

• Provide leadership with regular updates on test health, risks, and improvement opportunities.

• Manage tooling governance (Jira, ALM, Xray, Tosca, Selenium, Postman) and integration with DevOps QA pipelines.

Required Qualifications:

• Over 15 years of QA experience, including 5+ years in leadership or governance roles.

• Deep expertise in healthcare payer systems and regulatory frameworks such as HIPAA, CMS, NCQA.

• Proven experience in Agile, SAFe, and hybrid delivery models for test governance.

• Strong experience with EDI transaction testing and compliance audits.

• Excellent communication, stakeholder management, and quality reporting skills.

Preferred Skills:

• Certifications like ISTQB, PMP, SAFe, Six Sigma, HIPAA Compliance.

• Familiarity with healthcare platforms such as Facets, QNXT.

• Experience in establishing or managing a Testing Center of Excellence (TCOE).

Key Success Metrics:

• Adherence to QA SLAs and reduction in defect leakage.

• Readiness for audits and regulatory compliance in testing.

• Improved test automation ROI and coverage.

• Growth in QA maturity across programs.

• High business stakeholder satisfaction.

Note: Eligible candidates include GC, GCEAD, L2EAD, H4 EAD, and US Citizen consultants who can work on W2.