Senior Healthcare NASCO Claims Domain Specialist
Contract Corp To Corp
Contract Independent
Contract W2
12 Months
No Travel Required
On-site
Depends on Experience
Galaxy i Technologies, Inc.
Fitment
Dice Job Match Score™
👾 Reticulating splines...
Job Details
Skills
- Senior Healthcare NASCO Claims Domain Specialist
Summary
Job Title : Senior Healthcare NASCO Claims Domain Specialist (Claims Onsite Testing Lead)
Location : Newark, NJ (Onsite)
Location : Newark, NJ (Onsite)
JD:
Experience-15 to 20 years in Healthcare Insurance with strong NASCO claims domain expertise in testing
Role Overview
We are looking for a Senior Healthcare NASCO Claims Domain Specialist to lead and drive NASCO claims domain validation and testing initiatives for healthcare insurance applications.
This role requires deep hands on expertise in US healthcare claims processing, combined with the ability to mentor teams, guide testing strategy, and influence business decisions.
The candidate will work onsite with client stakeholders, serving as a trusted advisor and primary domain authority across projects.
Key Responsibilities
Senior NASCO Domain Leadership Serve as primary SME for end to end NASCO claims processing across professional, institutional, and pharmacy claims.
Provide strategic direction and domain leadership for claims testing initiatives.
Interpret and guide implementation of complex payer rules, benefit configurations, and provider contracts
Review and validate regulatory compliance with CMS, HIPAA, Medicare, Medicaid, and commercial plan requirements.
Proactively identify domain risks, gaps, and improvement opportunities in claims workflows.
Testing Strategy Governance Define overall NASCO claims testing strategy, scope, and coverage for releases.
Review and approve test plans, scenarios, and test data from a domain correctness perspective.
Ensure comprehensive validation of
oClaims adjudication logico Pricing and repricingo Accumulators (deductibles, MOOP)
oCOB and subrogationo Authorizations, edits, and exceptions Lead UAT planning and execution, including business readiness and sign off.
Own defect triage decisions, prioritization, and root cause analysis.Stake holder Onsite Engagement Act as single point of contact for claims domain queries at client location.
Partner closely with
oProduct Owners
o Business User
so Operations teams
o Development and QA leadsFacilitate workshops, walkthroughs, and requirement clarification sessions.
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
- Dice Id: 10374872
- Position Id: 35668-43206-1785338931
- Posted 9 hours ago
Company Info
About Galaxy i Technologies, Inc.
Galaxy i Technologies, Inc is a global consulting and IT services company that is known for its commitment to client satisfaction. Galaxy i Technologies is an information technology firm offering IT Consulting, Staff Augmentation, Software Development & Training and E-commerce Development. We help our Clients to implement these solutions through a variety of skilled consulting services like Application management, Implementation and Infrastructure management.
Galaxy i Technologies has a pool of highly skilled professionals who work through the life cycle of challenging and exciting projects, including System Analysis, Designing, Development, Implementation, Maintenance, Enhancements and Test Support to our Fortune 500 Corporations.
Careers
Galaxy i Technologies has a pool of highly skilled professionals who work through the life cycle of challenging and exciting projects, including System Analysis, Designing, Development, Implementation, Maintenance, Enhancements and Test Support to our Fortune 500 Corporations.
Careers
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