Job Summary
This hybrid role is for a claims processing professional in health care with focus on HIPAA compliance and claims adjudication for provider and payer clients in a night shift schedule. The role involves accurate review of health care claims application of benefit rules and timely resolution of discrepancies to support high quality member and provider experiences.
Responsibilities
- Review health care claims with close attention to detail to ensure accurate capture of member demographics benefit data and provider information while working in a hybrid night shift model
- Apply claims adjudication rules to determine eligibility coverage limits and cost sharing so that claims outcomes align with payer policies and contractual agreements
- Validate claims data for completeness and consistency and raise issues promptly so that incorrect information does not lead to payment errors or delays
- Interpret benefit plans and provider contracts to calculate member and payer financial responsibility and document outcomes clearly in the system of record
- Check claims against policy exclusions benefit maximums and coordination of benefits rules to minimize overpayments underpayments and rework
- Use HIPAA compliant workflows when accessing and updating member and provider information so that privacy and security requirements are consistently met
- Research claim discrepancies by referencing benefit documents historical claims and standard operating procedures to identify root causes and propose accurate resolutions
- Collaborate with internal operations quality and configuration teams through virtual channels to clarify benefits rules and ensure consistent adjudication outcomes across cases
- Respond to queries from provider and payer stakeholders by providing clear claim status updates and explanations that support trust and reduce repeat contacts
- Track individual claim queues and turnaround time targets during night shift schedules to support timely completion of work and achievement of service level commitments
- Document all claim decisions with clear rationales to enable audit readiness improve transparency and support training for future team members
- Identify recurring claim patterns such as coding mismatches or configuration gaps and escalate them for systematic fixes that enhance first pass resolution and reduce waste
- Contribute to continuous improvement activities by sharing observations from daily claim reviews that help refine processes tools and reference materials for the wider team
Qualifications
- Demonstrate working knowledge of HIPAA guidelines and privacy expectations in handling protected health information within claims processing environments
- Show foundational experience or training in claims adjudication workflows including eligibility checks benefit application and financial calculation steps
- Exhibit familiarity with payer operations including benefit structures claim payment life cycle and expectations for accuracy and turnaround time in health care settings
- Show understanding of provider perspectives including billing practices reimbursement expectations and common sources of claim inquiries or disputes
- Apply basic data entry and validation skills with strong emphasis on numeric accuracy and consistency when working with claim amounts and codes
- Use clear written and verbal communication skills to explain claim outcomes to internal stakeholders in concise and nontechnical language
- Display adaptability to hybrid work arrangements and night shift schedules while maintaining productivity and quality in a structured operations environment
コグニザントについて
コグニザント（NASDAQ: CTSH）は、AI Builderおよびテクノロジーサービスプロバイダーとして、お客様にフルスタックのAIソリューションを構築することで、AI投資と企業価値を結ぶ架け橋となっています。業界、ビジネスプロセス、エンジニアリングに関する当社の深い専門知識を活かし、組織固有のビジネス環境をテクノロジー・システムに組み込みます。これにより、人間の可能性を最大限に引き出し、確かな成果を実現するとともに、急速に変化する世界においてグローバル企業が常に一歩先を行くための支援を行っています。 詳細については、cognizant.ai をご覧ください。
雇用に関する追加情報
本募集に記載されている報酬情報は、掲載日時点で正確なものです。Cognizantは、適用される法令に従い、いつでも本情報を変更する権利を留保します。
応募者は、対面またはビデオ会議による面接への参加を求められる場合があります。また、各面接の際に、現在有効な州政府または政府発行の身分証明書の提示を求められる場合があります。
Cognizantは機会均等雇用主です。応募および選考において、人種、肌の色、性別、宗教、信条、性的指向、性自認、国籍、障がい、遺伝情報、妊娠、退役軍人の地位、その他連邦法・州法・地方自治体の法律により保護されるいかなる特性に基づく差別も行いません。
