Enterprise Test Strategy for TPA

Overview

A third-party administrator who supported payers with adjudicating out of network claims. The process involved time-sensitive and number-centric scenarios with complex test conditions and heavy test data dependency. The client’s key bottleneck was to edit solution functionality.  

Industry

Healthcare

Challenges

• Insufficient test coverage and test cycle time to conduct the edit code testing led to high functional defect leakages.  
• Extensive claims test data is needed as a pre-requisite to validate the Edits during every release cycle.  
• Test coverage and test data issues led to quality issues which directly impacted the revenue and dissatisfied customer experience.

Solutions

Genzeon took over the QA function from the in-house team and assessed the current QA. We defined a 30-60-90-day plan with the following focus:  

• Prepared the requirement traceability to determine coverage gaps 
• Built test cases to improve the overall test coverage 
• Initiated test automation to build the automated test coverage  
• Reduced the test data generation and cleanup process
• The 14-person onshore QA team was transitioned to an onshore/offshore model 

Benefits

Metrics improved significantly.

BEFORE AFTER

Total Test Cases: 800 Total Test Cases: 1,700

Automated Test Cases: 0 Automated Test Cases: 1,350

Defective Leakage: 8% Defective Leakage: 1%

Automation Coverage: 0% Automation Coverage: 80%

Test Data Effort: 16 hours each cycle Test Data Effort: 6 hours each cycle