Senior Healthcare NASCO Claims Domain Specialist
Duration: 6 months
Newark, NJ
Job description
Experience15- 20 years in Healthcare Insurance with strong NASCO claims domain expertise in testing
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 Claims adjudication logic Pricing and repricing Accumulators (deductibles, MOOP)cob and subrogation Authorizations, edits, and exceptions Lead UAT planning and execution, including business readiness and sign off.
Own defect triage decisions, prioritization, and root cause analysis.
Stakeholder Onsite Engagement Act as single point of contact for claims domain queries at client location.
Partner closely with Product Owners Business Users Operations Teams Development and QA leads Facilitate workshops, walkthroughs, and requirement clarification sessions.
Influence decision making by translating business needs into system impacts.
Team Leadership Mentorship Mentor junior and mid-level testers and analysts on healthcare claims concepts.
Review test artefacts and guide offshore UAT teams to ensure domain accuracy.
Promote best practices in domain driven testing and knowledge sharing.
Required Skills Qualifications Mandatory Domain Expertise Extensive experience in US Healthcare Insurance NASCO Claims Processing.
Strong understanding of Claims lifecycle and adjudication engines EDI
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