NASCO claims Specialist

Role: NASCO claims Specialist

Location: Newark, NJ

FTE

Salary - $115k/Annu

m
Job Descripti

on• Serve as primary SME for end to end NASCO claims processing across professional, institutional, and pharmacy claim

s.• Provide strategic direction and domain leadership for claims testing initiative

s.• Interpret and guide implementation of complex payer rules, benefit configurations, and provider contract

s.• Review and validate regulatory compliance with CMS, HIPAA, Medicare, Medicaid, and commercial plan requirement

s.• Proactively identify domain risks, gaps, and improvement opportunities in claims workflow

s.
Testing Strategy & Governa

nce• Define overall NASCO claims testing strategy, scope, and coverage for releas

es.• Review and approve test plans, scenarios, and test data from a domain correctness perspecti

ve.• Ensure comprehensive validation

of:o Claims adjudication lo

gico Pricing and repric

ingo Accumulators (deductibles, MO

OP)o COB and subrogat

iono Authorizations, edits, and excepti

ons• Lead UAT planning and execution, including business readiness and sign o

ff.• Own defect triage decisions, prioritization, and root cause analys

is.
Stakeholder & Onsite Engage

ment• Act as single point of contact for claims domain queries at client locat

ion.• Partner closely w

ith:o Product Ow

nerso Business U

serso Operations t

eamso Development and QA l

eads• Facilitate workshops, walkthroughs, and requirement clarification sessi

ons.• Influence decision making by translating business needs into system impa

cts.
Team Leadership & Mento

rship• Mentor junior and mid level testers and analysts on healthcare claims conc

epts.• Review test artefacts and guide offshore UAT teams to ensure domain accu

racy.• Promote best practices in domain driven testing and knowledge sha

ring.
Required Skills & Qualific

ationsMandatory Domain Exp

ertise• Extensive experience in US Healthcare Insurance – NASCO Claims Proce

ssing.• Strong understandi

ng of:o Claims lifecycle and adjudication e

ngineso EDI (837, 835, 27

0/271)o Coding standards: ICD 10, CPT, HCPC

S, DRGo Commercial, Medicare, and Medicaid

plans• Hands on experience supporting core payer plat

forms.
Testing & Process Exc

ellence• Strong manual testing background with senior level oversight expe

rience.• Expert

ise in:o Test strategy def

initiono UAT lea

dershipo Defect gov

ernance• Familiarity with Agile, SAFe, or hybrid delivery

models.• Experience with test management and defect tracking tools (Jira, ALM,