NASCO claims Specialist

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) o 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 o EDI (837, 835, 270/271)

Coding standards

• ICD 10, CPT, HCPCS, DRG o 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 o UAT leadership
• Defect governance
• Familiarity with Agile, SAFe, or hybrid delivery models.
• Experience with test management and defect tracking tools (Jira, ALM, qTest).

Salary Range

$110,000- $115,000 a year TCS Employee Benefits Summary: Discretionary Annual Incentive.

Comprehensive Medical Coverage

Medical & Health, Dental & Vision, Disability Planning & Insurance, Pet Insurance Plans.

Family Support

Maternal & Parental Leaves.

Insurance Options

Auto & Home Insurance, Identity Theft Protection.

Convenience & Professional Growth

Commuter Benefits & Certification & amp; Training Reimbursement.

Time Off

Vacation, Time Off, Sick Leave & Holidays.

Legal & Financial Assistance

Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing. #LI-SP1 </div

Qualifications

BACHELOR OF COMPUTER SCIENCE