NASCO claims Specialist

Job title: NASCO claims Specialist

Location: 100% Remote

Fulltime

Salary Range: $110,000-$115,000 a year+ Fulltime Benefit

Note : No C2C or contract roles; this position is for full-time employment only

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).

Thank you...!
Sourav Paul

Senior Technical Recruiter
E-mail: lucky.mishra@diverselynx.com

Direct Number: 2403594116

Phone Number: +1 7324521006 Ext:620

URL: https://www.linkedin.com/in/lucky-mishra-45481a252/
Diverse Lynx LLC
Consulting| Analytics| Staff Augmentation

URL: http://www.diverselynx.com

Address: 300 Alexander Park Dr Suite # 200 Princeton, New Jersey 08540