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.
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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:
oClaims adjudication logic
oPricing and repricing
oAccumulators (deductibles, MOOP)
oCOB and subrogation
oAuthorizations, edits, and exceptions
•Lead UAT planning and execution, including business readiness and sign off.
•Own defect triage decisions, prioritization, and root cause analysis.
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Stakeholder & Onsite Engagement
•Act as single point of contact for claims domain queries at client location.
•Partner closely with:
oProduct Owners
oBusiness Users
oOperations teams
oDevelopment and QA leads
•Facilitate workshops, walkthroughs, and requirement clarification sessions.
•Influence decision making by translating business needs into system impacts.
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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.
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Required Skills & Qualifications
Mandatory Domain Expertise
•Extensive experience in US Healthcare Insurance – NASCO Claims Processing.
•Strong understanding of:
oClaims lifecycle and adjudication engines
oEDI (837, 835, 270/271)
oCoding standards: ICD 10, CPT, HCPCS, DRG
oCommercial, Medicare, and Medicaid plans
•Hands on experience supporting core payer platforms.
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Testing & Process Excellence
•Strong manual testing background with senior level oversight experience.
•Expertise in:
oTest strategy definition
oUAT leadership
oDefect governance
•Familiarity with Agile, SAFe, or hybrid delivery models.
•Experience with test management and defect tracking tools (Jira, ALM, qTest).
Salary Range: $100,000- $125,000 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.
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More Information
Application Details
- Organization DetailsTCS / Tata Consultancy Services
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