NASCO Claims Domain Specialist

Purple Drive

NASCO Claims Domain Specialist Share Newark, NJ

Overview:

15+ years of experience in US Healthcare Insurance with strong NASCO Claims domain expertise.

Serve as the primary SME for end-to-end NASCO Claims Processing (Professional, Institutional, and Pharmacy claims).

Lead UAT planning, execution, validation, and business sign-off activities.

Strong knowledge of Claims Adjudication, Pricing/Repricing, Accumulators, COB, and Subrogation.

Review and validate test plans, test scenarios, test data, and claims workflows.

Expertise in EDI transactions including 837, 835, 270/271, and healthcare claims lifecycle.

Ensure compliance with CMS, HIPAA, Medicare, Medicaid, and Commercial Health Plan requirements.

Act as the key liaison between Business, Product Owners, Operations, Development, and QA teams.

Lead defect triage, root cause analysis, and testing governance activities.

Strong leadership, stakeholder management, and mentoring experience with onsite/offshore testing teams.