Responsibilities Include:

Serve as the primary Subject Matter Expert (SME) for end-to-end NASCO claims processing.
Lead testing strategy, planning, execution, and validation for healthcare claims applications.
Validate claims adjudication, pricing, repricing, deductibles, MOOP, Coordination of Benefits (COB), subrogation, authorizations, claims edits, and exception handling.
Review and approve test plans, test scenarios, test data, and test results.
Lead User Acceptance Testing (UAT), Functional Testing, System Integration Testing (SIT), and Regression Testing.
Conduct defect triage, root cause analysis, and release readiness activities.
Ensure compliance with CMS, HIPAA, Medicare, Medicaid, and commercial healthcare regulations.
Collaborate with Product Owners, Business Users, Development Teams, QA Leads, and Operations teams.
Facilitate requirement walkthroughs, workshops, and business validation sessions.
Mentor QA analysts and offshore UAT teams while promoting best testing practices.
Communicate project status, risks, and testing outcomes to business and technical stakeholders.

Qualifications:

15+ years of experience in U.S. Healthcare Insurance.
Extensive hands-on experience with NASCO Claims Processing.
Strong expertise in Healthcare Payer Claims and end-to-end Claims Lifecycle.
Experience with Professional, Institutional, and Pharmacy Claims.
Strong knowledge of Claims Adjudication, Benefit Configuration, Pricing, Repricing, Deductibles, MOOP, Coordination of Benefits (COB), Subrogation, Prior Authorization, and Claims Exception Handling.
Experience with EDI transactions including 837, 835, and 270/271.
Knowledge of CMS, HIPAA, Medicare, Medicaid, ICD, CPT, and HCPCS coding standards.
Hands-on experience leading UAT, Functional Testing, System Integration Testing (SIT), and Regression Testing.
Experience with

JIRA, HP

ALM, or similar test management tools.

Knowledge of SQL for data validation is preferred.
Strong stakeholder management, communication, leadership, and mentoring skills.

Important Details:

Employment Type:

Contract

Work Location:

Newark, NJ

Company HQ:

New York

Target Bill Rate:

45$/hr - $50/hr

Schedule:

Monday-Friday, standard business hours

Benefits:

PTO, 401k Retirement Contribution This hot job won t be open long

APPLY TODAY!

Russell Tobin is a leading minority-owned professional and technical recruitment and staffing advisory organization.

We are comprised of specialized practices focusing on a variety of skill sets and industries. Having a depth and breadth of industry expertise, our subject matter experts are able to provide tailored and swift sourcing solutions to fulfill client hiring needs. In other words, we connect top talent with companies. We are the staffing arm of the Pride Global network, a minority-owned integrated human capital solutions firm, with additional offerings in vendor management, payroll programs, and business process optimization.

Russell Tobin offers eligible employee s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors.

Equal Employment Opportunity

Russell Tobin is an equal opportunity employer.

We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law. Fair Chance Employment

Russell Tobin is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances. Accommodation
We are committed to providing reasonable accommodation to applicants and employees with disabilities.

If you require reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us. Only applicable for

San Francisco Candidates:

Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.

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