Job Summary
This hybrid night shift role focuses on end to end health care claims adjudication and compliance driven processing using HIPAA standards within payer and provider environments ensuring accurate decisions reduced leakages and improved member and provider experience for a global client base while contributing to high quality timely claim outcomes and sustainable business value.
Responsibilities
- Analyze complex health care claims with strong focus on HIPAA compliance and adjudication rules to deliver accurate and timely claim decisions that support client service excellence and financial integrity for payer and provider organizations.
- Apply detailed knowledge of benefits coverage policies and coordination of benefits to interpret claim data and determine appropriate payment or denial outcomes that minimize rework and prevent revenue leakage.
- Review claim edits audits and exception queues to validate rule application and propose refinements that enhance auto adjudication rates while maintaining regulatory and contractual compliance.
- Collaborate with payer operations provider relations and technical configuration teams in a hybrid model to clarify benefit designs fee schedules and contract terms that influence claim outcomes and member impact.
- Document claim decisions rationales and adjustments in clear structured formats that enable downstream analytics audit readiness and transparent communication to internal stakeholders and external partners.
- Identify recurring adjudication issues such as coding discrepancies or benefit misinterpretations and coordinate with configuration and policy teams to drive sustainable remediation and continuous improvement.
- Monitor night shift operational metrics such as turnaround time queue aging and quality scores to prioritize daily work and escalate risk items that may affect service level commitments.
- Perform root cause analysis on claim disputes rejections and appeals to recommend corrective actions that reduce future errors and enhance member and provider satisfaction.
- Coordinate closely with quality assurance and training teams to provide feedback on process gaps participate in calibration discussions and support refinement of adjudication guidelines and reference materials.
- Support knowledge sharing within the team by capturing complex adjudication scenarios edge cases and best practices that help new and existing team members resolve similar cases more efficiently.
- Engage with cross functional technical teams to validate data mappings system behaviors and integration touchpoints that influence claim intake pricing and payment processing in the end to end claims life cycle.
- Adhere to information security privacy and data handling standards in all aspects of claims work to safeguard member and provider information and to comply with organizational and regulatory requirements.
- Adapt work planning and coordination to the hybrid work model by using collaboration tools virtual meetings and clear documentation practices that support effective communication across locations and time zones.
- Manage night shift responsibilities with strong self organization and proactive communication to ensure stable coverage accurate handoffs and uninterrupted service for global client operations.
Qualifications
- Exhibit deep hands on experience in HIPAA transaction standards and privacy concepts applied to real world claim adjudication scenarios across multiple health plans and lines of business.
- Demonstrate expert level knowledge of claims adjudication processes including eligibility verification benefit determination pricing logic accumulators and post adjudication adjustments.
- Show strong domain understanding of payer operations such as benefits administration provider contracts utilization management touchpoints and claims payment workflows.
- Display sound knowledge of provider perspectives including reimbursement expectations coding and billing practices and common claim dispute drivers that influence operational efficiency.
- Utilize analytical and problem solving skills to interpret structured and unstructured claim data identify patterns and recommend process or configuration enhancements with measurable impact.
- Communicate clearly and professionally in written and spoken form to explain adjudication outcomes clarify requirements and collaborate effectively with diverse technical and business stakeholders.
- Leverage experience working in structured shift environments to maintain consistent productivity focus and quality during night shift operations while following organizational policies.
- Applied experience range of eight to nine years in health care claims and related payer or provider processes enabling independent resolution of complex cases and mentoring support for peers.
What we offer
- The chance to work with impact. Here, you’re empowered to bring your biggest thinking to help our company and clients improve everyday life.
- Ownership over your career. Stay at the top of your game through our award-winning learning and development ecosystem. And when your ambitions change or we offer new opportunities, we help you pivot by providing reskilling, on-the-job learning and guidance to find new roles that might be a better fit.
- The opportunity to thrive on a high caliber team with heart. We celebrate each other’s experiences and perspectives and promote a sense of belonging through our affinity groups and diversity and inclusion initiatives.
- A comprehensive total rewards package, including a competitive salary and a pension plan with matching contributions.
- Flexible health and financial benefits to support you and your eligible dependents—from day one.
- True work-life balance. Be at your best through paid time off, flexible work arrangements, volunteering opportunities, social events, and so much more.
About us
Cognizant (Nasdaq: CTSH) is an AI Builder and technology services provider, building the bridge 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, realize tangible returns and keep global enterprises ahead in a fast-changing world. See how at www.cognizant.com or @cognizant.
Other employment-related information
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, provincial or local laws.
If you have a disability that requires reasonable accommodation to search for a job opening or submit an application, please email [email protected] with your request and contact information.
Language requirements vary depending on roles, but we ask that all candidates have basic English proficiency for company-wide communications purposes. For roles based in Quebec, professional English proficiency is required, as you’ll deliver services to and collaborate with stakeholders outside the province who may not speak French.
