NASCO claims Specialist

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. ________________________________________ 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: 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. ________________________________________ 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. UAT leadership Familiarity with Agile, SAFe, or hybrid delivery models. Experience with test management and defect tracking tools (Jira, ALM, qTest). #J-18808-Ljbffr Centraprise