Information Technology_USA - USA_Analyst

**Please strictly adhere to the following resume naming convention:

ALL CAPS, NO SPACES B/T UNDERSCORES

PTN_US_GBAMSREQID_CandidateBeelineID

i.e. PTN_US_9999999_SKIPJOHNSON0413

MSP Owner: William Bristol
Location: See Below
Duration: 6 months

JD:

Job TitleSenior Healthcare NASCO Claims Domain Specialist Insurance UAT Testing (Onsite)Job LocationOnsite Client Location (Newark, NJ)Experience15 20 years in Healthcare Insurance with strong NASCO claims domain expertise in testing Role OverviewWe 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 ResponsibilitiesSenior NASCO Domain LeadershipServe 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 GovernanceDefine 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 logicoPricing and repricingoAccumulators (deductibles, MOOP)oCOB and subrogationoAuthorizations, edits, and exceptionsLead UAT planning and execution, including business readiness and sign off.Own defect triage decisions, prioritization, and root cause analysis.Stakeholder Onsite EngagementAct as single point of contact for claims domain queries at client location.Partner closely with oProduct OwnersoBusiness UsersoOperations teamsoDevelopment and QA leadsFacilitate workshops, walkthroughs, and requirement clarification sessions.Influence decision making by translating business needs into system impacts.Team Leadership MentorshipMentor 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 QualificationsMandatory Domain ExpertiseExtensive experience in US Healthcare Insurance NASCO Claims Processing.Strong understanding of oClaims lifecycle and adjudication enginesoEDI (837, 835, 270271)oCoding

Key responsibilities

Job TitleSenior Healthcare NASCO Claims Domain Specialist Insurance UAT Testing (Onsite)Job LocationOnsite Client Location (Newark, NJ)Experience15 20 years in Healthcare Insurance with strong NASCO claims domain expertise in testing Role OverviewWe 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 ResponsibilitiesSenior NASCO Domain LeadershipServe 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 GovernanceDefine 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 logicoPricing and repricingoAccumulators (deductibles, MOOP)oCOB and subrogationoAuthorizations, edits, and exceptionsLead UAT planning and execution, including business readiness and sign off.Own defect triage decisions, prioritization, and root cause analysis.Stakeholder Onsite EngagementAct as single point of contact for claims domain queries at client location.Partner closely with oProduct OwnersoBusiness UsersoOperations teamsoDevelopment and QA leadsFacilitate workshops, walkthroughs, and requirement clarification sessions.Influence decision making by translating business needs into system impacts.Team Leadership MentorshipMentor 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 QualificationsMandatory Domain ExpertiseExtensive experience in US Healthcare Insurance NASCO Claims Processing.Strong understanding of oClaims lifecycle and adjudication enginesoEDI (837, 835, 270271)oCoding

Role Descriptions: Claims Onsite Testing Lead Role SummaryThe Claims Onsite Testing Lead is responsible for planning| managing| and executing end to end testing activities for insurance claims systems while working closely with onsite business stakeholders| development teams| and offshore UAT-CoE teams. This role ensures that claims processing applications meet business requirements| regulatory standards| and quality expectations before production release.Key ResponsibilitiesTesting Leadership CoordinationAct as the primary onsite point of contact for all claims testing activitiesLead and manage functional| system| integration| regression| and UAT testing for insurance claims applicationsCoordinate testing efforts between onsite business users| IT teams| and offshore UAT-COE teamsCreate| review| and maintain test strategy| test plans| and test schedulesClaims Domain Functional ExpertiseUnderstand end to end insurance claims life cycle (FNOL| coverage validation| adjudication| payments| recoveries| subrogation| and closure)Translate business requirements| policy rules| and regulatory needs into effective test scenariosValidate claim calculations| deductible logic| reserves| payments| and settlement accuracyTest Design ExecutionReview and approve test cases| test data| and test execution resultsEnsure comprehensive coverage across claim types| policy variations| and exception scenariosMonitor test execution progress and ensure timelines and quality standards are metSupport UAT business by guiding business users and resolving functional test issuesDefect Management Quality AssuranceLead defect triage meetings and collaborate with development teams for root cause analysisEnsure proper defect documentation| prioritization| and resolutionTrack defect metrics and provide regular quality status reports to stakeholdersReporting Stakeholder CommunicationCommunicate testing status| risks| and mitigation plans to project managers and business leadsProvide gono go recommendations for release readinessFacilitate walkthroughs| demos| and test result reviewsCompliance Continuous ImprovementEnsure compliance with insurance regulations| audit requirements| and internal quality standardsIdentify opportunities to improve test processes| tools| and automation strategiesMentor junior testers and promote best practices across testing teamsRequired Skills QualificationsProfessional Experience7 years of experience in insurance claims testing or claims systems validation2 years of experience in a test lead or onsite coordinator roleTechnical Testing SkillsStrong knowledge of manual testing methodologies and UATCoE best practicesExperience with test management tools (e.g.| ALM| JIRA)Familiarity with claims systems (legacy claims systems preferred) and vendor partner testingUnderstanding of SQL or basic data validation techniques is an advantageDomain KnowledgeIn depth understanding of PC| Life| or Health i
Essential Skills: Claims Onsite Testing LeadRole SummaryThe Claims Onsite Testing Lead is responsible for planning| managing| and executing end to end testing activities for insurance claims systems while working closely with onsite business stakeholders| development teams| and offshore UAT-CoE teams. This role ensures that claims processing applications meet business requirements| regulatory standards| and quality expectations before production release.Key ResponsibilitiesTesting Leadership CoordinationAct as the primary onsite point of contact for all claims testing activitiesLead and manage functional| system| integration| regression| and UAT testing for insurance claims applicationsCoordinate testing efforts between onsite business users| IT teams| and offshore UAT-COE teamsCreate| review| and maintain test strategy| test plans| and test schedulesClaims Domain Functional ExpertiseUnderstand end to end insurance claims life cycle (FNOL| coverage validation| adjudication| payments| recoveries| subrogation| and closure)Translate business re