| Job Description: |
Job Title: Senior Healthcare NASCO Claims Domain Specialist – Insurance UAT Testing
Job Location: Chennai / Hyderabad
Experience: 8-10 years in Healthcare Insurance with strong NASCO claims domain expertise in testing
Role Overview
• We are looking for a Senior Healthcare NASCO Claims Domain Specialist to lead and drive NASCO claims domain validation and testing initiatives for healthcare insurance applications. This role requires deep hands-on expertise in US healthcare claims processing, combined with the ability to mentor teams, guide testing strategy, and influence business decisions.
• The candidate will work onsite with client stakeholders, serving as a trusted advisor and primary domain authority across projects.
Key Responsibilities
• Senior NASCO Domain Leadership
• 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.
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).
Soft Skills & Leadership
• Excellent client-facing communication and presentation skills.
• Strong decision-making and negotiation abilities.
• Ability to handle ambiguity and complex business scenarios.
• Proven experience influencing stakeholders without direct authority.
Preferred Qualifications
• Prior experience with NASCO Claims testing, Facets, QNXT, Amisys, HealthEdge, or similar platforms.
• Experience leading large claims transformation or modernization programs.
• Certifications in Healthcare, Insurance, or Testing methodologies.
Why This Role Is Senior
• Owns domain decisions, not just execution
• Leads UAT NASCO claims testing and business sign-off
• Acts as trusted advisor to client stakeholders
• Mentors' teams and shapes testing strategy |
