Job Summary
Role focuses on managing health care product operations and denial processing workflows in a hybrid night shift environment ensuring accurate claim handling issue resolution and continuous improvement for global stakeholders while maintaining strong quality standards and contributing to better patient and provider outcomes through efficient back office support.
Responsibilities
Manage daily work queues for health care product related cases and denial processing items to ensure timely resolution and adherence to agreed service levels for internal and external stakeholders.Analyze denial trends across multiple health care product lines and identify actionable insights that support reduction of repeat issues and improvement of payment accuracy.Coordinate with cross functional teams including operations quality and product support to clarify complex denial scenarios and ensure consistent application of rules and guidelines.Review claim and denial documentation with strong attention to detail to validate required information and minimize processing errors that impact members and providers.Maintain up to date knowledge of health care product features benefit structures and denial categories in order to apply correct decision logic during night shift operations.Document case handling steps root causes and resolutions in workflow tools to enable transparent reporting and support future audits and continuous improvement initiatives.Support implementation of process changes and system enhancements related to denial processing by providing practical feedback based on day to day case management experience.Provide clear written communication in standard templates to internal teams regarding denial outcomes required actions and escalations ensuring professional and neutral language at all times.Monitor individual productivity and quality metrics during hybrid work arrangements and proactively adjust work patterns to meet both performance expectations and compliance norms.Escalate unusual patterns such as potential system defects or policy ambiguities that influence multiple denial cases and collaborate with designated teams to drive timely corrective actions.Contribute to training refreshers by sharing case examples and best practices that help colleagues handle complex health care product denials more efficiently and consistently.Adhere strictly to company compliance requirements including data privacy and regulatory guidelines while processing sensitive health care information in night shift schedules.Support the organizations broader purpose by helping reduce administrative burden for providers and members through accurate efficient denial management that improves trust in health care services.
Qualifications
Demonstrate hands on experience working with health care products and related operational processes over at least two years with clear understanding of benefit rules and claim flows.Apply specialized knowledge in denial processing including categorization root cause identification and corrective action planning in alignment with standard operating procedures.Utilize analytical skills to interpret denial metrics spot recurring issues and recommend targeted improvements that enhance operational efficiency and service quality.Communicate effectively in written and verbal forms to collaborate with global teams during night shift operations while maintaining professional tone and clarity.Operate comfortably in a hybrid work model using enterprise workflow tools communication platforms and reporting dashboards to manage tasks and share updates.Follow structured problem solving approaches and display resilience in handling high volume denial workloads within tight timelines without compromising accuracy.
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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