NASCO Claims Domain Specialist
Purple Drive
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.
Vacancy posted 4 hours ago
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