Job Summary
Serve as a team level specialist for enrollment and billing operations in a hybrid night shift role ensuring accurate benefits open enrollment processing and adherence to HIPAA standards for payer and provider clients. Collaborate with cross functional stakeholders to resolve member issues prevent billing discrepancies and support continuous improvement in core healthcare administration services.
Responsibilities
- Manage day to day enrollment and billing activities for payer and provider accounts to ensure timely and accurate processing of member transactions across multiple systems and files.
- Coordinate benefits open enrollment cycles by validating eligibility data plan selections and contributions so that members receive correct coverage and billing from the effective date.
- Monitor inbound eligibility and billing feeds to identify missing inconsistent or duplicate records and drive prompt remediation that prevents downstream financial or service impact.
- Analyze complex member enrollment scenarios such as multiple coverage changes qualifying life events and retroactive updates to determine appropriate system updates and adjustments.
- Apply HIPAA standards in every transaction by following privacy safeguards minimum necessary data principles and secure handling of protected health information.
- Document detailed processing steps exception patterns and resolutions so that the team knowledge base supports faster onboarding and consistent service delivery.
- Collaborate with payer and provider operations finance and call center teams to resolve enrollment and billing disputes that affect claims adjudication and member satisfaction.
- Use reporting and dashboards to track work queues error rates turnaround times and backlog so that service level commitments for night shift operations are consistently met.
- Perform quality checks on enrollment batches and billing runs to verify correct premiums employer contributions and dependent coverage before finalization.
- Support system configuration activities related to new benefit plans billing rules and enrollment codes so that implementation aligns with client requirements.
- Communicate clearly with stakeholders through concise status updates issue logs and escalation notes that enable informed decisions during critical enrollment periods.
- Train and mentor junior team members in standard procedures HIPAA compliant practices and domain specific scenarios so that overall team capability improves steadily.
- Participate in root cause analysis for recurring enrollment or billing errors and recommend process or configuration changes that reduce rework and financial leakage.
Qualifications
- Possess four to five years of hands on experience in enrollment and billing operations within healthcare payer and provider environments with consistent exposure to complex member scenarios.
- Demonstrate strong practical knowledge of benefits open enrollment processes including eligibility intake plan mapping rate structures and effective date rules.
- Exhibit advanced understanding of HIPAA regulations as they apply to enrollment billing and data exchange so that compliance risks are proactively mitigated.
- Show proven ability to interpret payer and provider business rules benefit designs and contract terms and translate them into accurate enrollment and billing outcomes.
- Display proficiency with spreadsheets ticketing tools and enrollment platforms to analyze data files reconcile discrepancies and document case work thoroughly.
- Communicate effectively in written and spoken form during night shift hours with global stakeholders to clarify requirements and resolve issues without service delays.
- Adapt quickly to changing client needs peak open enrollment volumes and new plan year configurations while maintaining high quality and attention to detail.
About Cognizant:
Cognizant (Nasdaq: CTSH) is an AI Builder and technology services provider, bridging the gap 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, drive tangible outcomes and keep global enterprises ahead in a fast-changing world. See how at cognizant.ai or @cognizant.
Additional employment information
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.
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.
