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SPE-Claims HC

00068443681



Job Summary

This role focuses on claims adjudication processes within the healthcare domain ensuring accuracy and compliance in claims handling. The candidate will work in a night shift from the office contributing to efficient payer operations and delivering impactful results for the organization.


Responsibilities

  • Process claims adjudication tasks with precision and ensure compliance with organizational policies and industry standards.
  • Analyze claims data to identify discrepancies and resolve issues effectively ensuring timely adjudication.
  • Collaborate with internal teams to streamline claims workflows and improve operational efficiency.
  • Utilize technical expertise in claims adjudication to handle complex cases and provide accurate resolutions.
  • Maintain up-to-date knowledge of healthcare regulations and payer guidelines to ensure adherence in claims processing.
  • Monitor claims adjudication metrics and provide insights for continuous improvement in processes.
  • Communicate effectively with stakeholders to address queries and provide updates on claims status.
  • Support the implementation of new tools and technologies to enhance claims adjudication processes.
  • Ensure confidentiality and security of sensitive claims data in compliance with organizational and regulatory requirements.
  • Provide training and guidance to team members on claims adjudication best practices and tools.
  • Contribute to the development of documentation and reports related to claims adjudication activities.
  • Participate in regular audits and reviews to ensure quality and accuracy in claims processing.
  • Work collaboratively in a night shift environment to meet organizational goals and deliver impactful results.

    • Qualifications

  • Demonstrate strong expertise in claims adjudication processes ensuring accuracy and compliance.
  • Possess knowledge of healthcare domain skills including claims and payer operations as a nice-to-have qualification.
  • Exhibit excellent analytical skills to identify and resolve discrepancies in claims data.
  • Showcase effective communication skills to collaborate with internal teams and stakeholders.
  • Display proficiency in utilizing tools and technologies relevant to claims adjudication.
  • Maintain a detail-oriented approach to ensure quality and accuracy in claims processing.
  • Adapt to a night shift work model and contribute effectively to team goals.
  • Uphold confidentiality and security standards in handling sensitive claims information.
  • Demonstrate a proactive attitude towards learning and improving claims adjudication processes.
  • Provide insights and recommendations for enhancing operational efficiency in claims workflows.
  • Exhibit a commitment to delivering impactful results that align with organizational objectives.
  • Stay updated on healthcare regulations and payer guidelines to ensure compliance.

    • Certifications Required

    Certified Professional Coder (CPC) Certified Healthcare Claims Professional (CHCP)

    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.