Job Summary
The role of SPE Claims HC focuses on analyzing and supporting healthcare product solutions within payer EDI environments ensuring accurate and efficient handling of electronic claims and related transactions. The candidate will contribute to improving claims processing workflows enhancing data quality and supporting stakeholders through precise documentation and communication in English while working in a hybrid day shift model.
Responsibilities
Analyze healthcare product specifications and claims processing rules to ensure that payer EDI transactions are implemented accurately and conform to organizational standards and industry regulationsSupport end to end lifecycle of healthcare claims within payer EDI systems by monitoring transaction flows and identifying data or configuration issues that impact timely adjudicationCollaborate with cross functional teams to translate business requirements from healthcare stakeholders into clear and testable functional specifications for EDI payer solutionsCoordinate with technology and operations teams to validate that changes to healthcare products and claims rules are correctly implemented and do not introduce defects in EDI payer processesConduct detailed root cause analysis for issues in healthcare claims and payer EDI transactions and document findings to enable sustainable corrective actions and knowledge reusePerform structured testing of healthcare product changes and EDI payer enhancements by preparing test scenarios data sets and expected results that reflect real world claim situationsProvide concise and accurate documentation for healthcare products payer EDI workflows and claims handling procedures to support knowledge transfer and operational continuityCommunicate clearly in English with internal stakeholders to present analysis outcomes status updates and recommendations that improve transparency of claims processing activitiesRecommend improvements to claims processing and EDI payer workflows by using insights from defect patterns turnaround times and data quality metrics to enhance efficiency and member outcomesSupport compliance alignment by validating that healthcare product configurations and payer EDI transactions adhere to relevant standards and organizational controls related to privacy and data integrityAssist in incident and defect management by tracking reported issues prioritizing remediation actions and verifying that fixes to claims and EDI payer logic are effective before deploymentContribute to the hybrid work environment by maintaining consistent productivity collaboration and timely communication using digital tools while operating primarily in day shift with no travel requirementsUtilize knowledge of commercial claims when applicable to compare process variations and propose reusable patterns that strengthen claims management practices across multiple lines of business
Qualifications
Demonstrate practical experience in healthcare products by applying understanding of benefit structures claim rules and policy configurations to support reliable claims processingApply working knowledge of EDI payer domain concepts by handling transaction sets data elements and business rules that govern electronic claims and related administrative exchangesUse familiarity with commercial claims as a helpful asset when analyzing scenarios that involve different funding arrangements coverage types and adjudication methods within claims environmentsCommunicate fluently in English through reading writing and speaking to ensure that requirements documentation defect descriptions and stakeholder interactions are precise and easy to understandOperate effectively within a hybrid work model by managing time self organization and collaboration tools to meet delivery expectations while working primarily in a day shift scheduleAdapt prior industry or project experience of two to four years to new healthcare and payer EDI contexts by quickly learning system nuances and applying structured problem solving methods
Certifications Required
Recommended certifications include Certified Professional in Healthcare Information and Management Systems or equivalent healthcare IT credential.
关于高知特 (Cognizant)
高知特(Cognizant)（纳斯达克代码：CTSH）作为一家AI Builder和相关技术服务提供商，致力于通过打造全栈AI解决方案，帮助企业将人工智能投资转化为实际价值。公司凭借深厚的行业经验、流程优化和工程技术专长，将企业独特的业务场景融入科技系统，赋能组织释放人才潜能，推动切实成果，并帮助全球企业在瞬息万变的环境中保持领先。如需了解更多详情，敬请访问 cognizant.ai 或关注@cognizant。
补充雇佣信息
薪酬信息截至本职位发布之日为准。Cognizant 保留在适用法律允许的范围内随时修改该信息的权利。
申请人可能需要通过现场面试或视频会议的方式参加面试。此外，候选人在每次面试时可能需要出示其当前所在州或政府签发的有效身份证件。
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