NASCO claims Specialist
$110k - $115kTata Consultancy Services
Job Description Key Responsibilities 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 (837, 835, 270/271)
Coding standards: ICD 10, CPT, HCPCS, DRG Commercial, Medicare, and Medicaid plans Hands on experience supporting core payer platforms. Testing & Process Excellence Strong manual testing background with senior level oversight experience. Expertise in: Test strategy definition UAT leadership Defect governance Familiarity with Agile, SAFe, or hybrid delivery models. Experience with test management and defect tracking tools (Jira, ALM, qTest). Salary Range $110,000- $115,000 a year TCS Employee Benefits Summary Discretionary Annual Incentive. Comprehensive Medical Coverage: Medical & Health, Dental & Vision, Disability Planning & Insurance, Pet Insurance Plans. Family Support: Maternal & Parental Leaves. Insurance Options: Auto & Home Insurance, Identity Theft Protection. Convenience & Professional Growth: Commuter Benefits & Certification & Training Reimbursement. Time Off: Vacation, Time Off, Sick Leave & Holidays. Legal & Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing. QualificationsBACHELOR OF COMPUTER SCIENCE
#J-18808-Ljbffr Tata Consultancy ServicesVacancy posted 2 days ago
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