Job Title : Senior Healthcare NASCO Claims Domain Specialist (Claims Onsite Testing Lead)
Location : Newark, NJ (Onsite)
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.
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