Job Summary
Serve as a claims adjudication specialist within a global healthcare services organization applying strong expertise in MS Excel and medical claims processing for provider and payer domains. Contribute to accurate timely and compliant evaluation of healthcare claims in a hybrid work model with night shifts supporting operational excellence and better health outcomes.
Responsibilities
- Review healthcare claims for provider and payer accounts with careful attention to policy rules eligibility criteria and benefit structures to ensure accurate adjudication and reduce payment errors.
- Analyze claim data in MS Excel using filters lookups pivot tables and structured worksheets to identify discrepancies trends and patterns that support continuous improvement in claim handling.
- Validate key claim elements such as member information provider details coding consistency and billed amounts to help maintain high levels of data integrity and regulatory compliance.
- Apply adjudication guidelines and standard operating procedures consistently across all assigned claims to ensure fair processing outcomes and strengthen trust among healthcare stakeholders.
- Coordinate with internal operations and quality teams to clarify claim related questions and document resolutions that improve process efficiency and reduce repeat issues.
- Maintain detailed and well organized claim tracking logs in spreadsheet templates to monitor status turnaround times and escalations supporting transparent reporting to management.
- Respond to claim inquiries from authorized internal partners in a timely and professional manner providing clear explanations of adjudication decisions that support customer satisfaction.
- Collaborate with colleagues in the hybrid work environment to share best practices in MS Excel usage claim interpretation and payer or provider rules promoting a culture of knowledge sharing.
- Follow defined controls for night shift operations including adherence to cut off times productivity targets and quality metrics to support global service levels with minimal disruption.
- Support audit readiness by maintaining accurate digital records and standardized documentation of claim decisions enabling thorough review and continuous enhancement of control frameworks.
- Contribute to process optimization initiatives by suggesting refinements to templates checklists and validation steps helping the company improve cost effectiveness and healthcare affordability.
- Adhere to privacy and confidentiality requirements when handling sensitive member and provider information thereby protecting individual rights and reinforcing organizational integrity.
- Participate in training sessions and updates related to regulatory changes payer policies and provider contracting rules ensuring that claim adjudication remains current and compliant.
Qualifications
- Demonstrate practical experience using MS Excel for data entry validation analysis and reporting in a production environment with strong attention to accuracy and consistency.
- Exhibit hands on exposure to claims adjudication workflows in healthcare including verification coding interpretation and resolution of discrepancies for both provider and payer scenarios.
- Show understanding of provider operations such as billing practices contract terms and reimbursement models enabling precise evaluation of claims and reductions in disputes.
- Apply knowledge of payer processes including benefit structures policy provisions and denial management approaches to support correct payment decisions and lower rework volumes.
- Display strong analytical and problem solving abilities with capacity to investigate claim issues methodically and propose data based solutions that support smoother operations.
- Communicate clearly in written and verbal form with cross functional stakeholders explaining complex claim outcomes in accessible language that helps drive informed decisions.
- Adapt effectively to hybrid working arrangements and night shift schedules while maintaining high productivity and meeting defined accuracy thresholds and performance expectations.
Certifications Required
Preferred certification in medical claims processing or health insurance such as Certified Professional Coder CPC or equivalent.
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。
