Job Summary
This role focuses on claims adjudication processes within the healthcare domain ensuring accuracy and compliance in claims handling. The candidate will work in a night shift from the office contributing to efficient payer operations and delivering impactful results for the organization.
Responsibilities
Process claims adjudication tasks with precision and ensure compliance with organizational policies and industry standards.Analyze claims data to identify discrepancies and resolve issues effectively ensuring timely adjudication.Collaborate with internal teams to streamline claims workflows and improve operational efficiency.Utilize technical expertise in claims adjudication to handle complex cases and provide accurate resolutions.Maintain up-to-date knowledge of healthcare regulations and payer guidelines to ensure adherence in claims processing.Monitor claims adjudication metrics and provide insights for continuous improvement in processes.Communicate effectively with stakeholders to address queries and provide updates on claims status.Support the implementation of new tools and technologies to enhance claims adjudication processes.Ensure confidentiality and security of sensitive claims data in compliance with organizational and regulatory requirements.Provide training and guidance to team members on claims adjudication best practices and tools.Contribute to the development of documentation and reports related to claims adjudication activities.Participate in regular audits and reviews to ensure quality and accuracy in claims processing.Work collaboratively in a night shift environment to meet organizational goals and deliver impactful results.
Qualifications
Demonstrate strong expertise in claims adjudication processes ensuring accuracy and compliance.Possess knowledge of healthcare domain skills including claims and payer operations as a nice-to-have qualification.Exhibit excellent analytical skills to identify and resolve discrepancies in claims data.Showcase effective communication skills to collaborate with internal teams and stakeholders.Display proficiency in utilizing tools and technologies relevant to claims adjudication.Maintain a detail-oriented approach to ensure quality and accuracy in claims processing.Adapt to a night shift work model and contribute effectively to team goals.Uphold confidentiality and security standards in handling sensitive claims information.Demonstrate a proactive attitude towards learning and improving claims adjudication processes.Provide insights and recommendations for enhancing operational efficiency in claims workflows.Exhibit a commitment to delivering impactful results that align with organizational objectives.Stay updated on healthcare regulations and payer guidelines to ensure compliance.
Certifications Required
Certified Professional Coder (CPC) Certified Healthcare Claims Professional (CHCP)
The Cognizant community:
We are a high caliber team who appreciate and support one another. Our people uphold an energetic, collaborative and inclusive workplace where everyone can thrive.
- Cognizant is a global community with more than 300,000+ associates around the world.
- We don’t just dream of a better way – we make it happen.
- We take care of our people, clients, company, communities and climate by doing what’s right.
- We foster an innovative environment where you can build the career path that’s right for you.
About us:
Cognizant (Nasdaq: CTSH) is an AI Builder and technology services provider, building the bridge between AI investment and enterprise value by building full-stack AI solutions for our clients. Our deep industry, process and engineering expertise enables us to build an organization’s unique context into technology systems that amplify human potential, realize tangible returns and keep global enterprises ahead in a fast-changing world. See how at www.cognizant.com or @cognizant.
Cognizant is an equal opportunity employer. Your application and candidacy will not be considered based on race, color, sex, religion, creed, sexual orientation, gender identity, national origin, disability, genetic information, pregnancy, veteran status or any other characteristic protected by federal, state or local laws.
Disclaimer:
Compensation information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.
Applicants may be required to attend interviews in person or by video conference. In addition, candidates may be required to present their current state or government issued ID during each interview.
