Experience: 8-10 years in Healthcare Insurance with robust 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
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📌 NASCO US Healthcare. (Delhi)
🏢 Clifyx
📍 Delhi
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