SPE-Claims HC, Chennai, Tamil Nadu, India

Job Summary

This role focuses on specialized processing and analysis of commercial health care claims ensuring accurate adjudication and compliance for complex insurance products. The candidate will apply deep expertise in health care products and commercial claims workflows to improve claim quality reduce operational risk and enhance customer outcomes in a hybrid day shift environment using English for effective communication.

Responsibilities

Analyze end to end commercial health care claims to ensure accurate interpretation of policy benefits eligibility rules and coverage conditions driving reliable claim outcomes and minimizing financial leakage

Review claim documentation and associated health care product information to validate data completeness and consistency enabling accurate decision making and timely resolution for stakeholders

Coordinate with operations and product teams to clarify claim handling rules for health care products ensuring standardized application of guidelines and reducing processing errors across claim portfolios

Investigate claim discrepancies and exceptions using structured analysis techniques identifying root causes and proposing process improvements that enhance claim accuracy and customer satisfaction

Document claim decisions and rationales clearly in case management tools providing transparent audit trails and supporting compliance with regulatory and internal quality standards

Collaborate with quality assurance teams to participate in claim reviews and sample assessments contributing insights that refine health care product rules and strengthen commercial claims governance

Utilize claim processing systems and tools efficiently during day shift operations maintaining high throughput while adhering to service level expectations and accuracy benchmarks

Engage constructively with cross functional partners through English communication to clarify complex claim scenarios reducing cycle time and improving mutual understanding of product rules

Monitor key indicators related to commercial claims performance such as adjustment rates and rework volumes helping to identify patterns that inform training needs and product guideline updates

Support the onboarding of new claim scenarios or product changes by interpreting business requirements into operational claim rules ensuring smooth integration into daily processing routines

Provide clear feedback to internal teams on recurring claim issues tied to health care products helping refine documentation standards and promote continuous improvement in claim workflows

Maintain strict adherence to company policies and regulatory expectations for data privacy and claim handling protecting member information and reinforcing organizational trust in claims operations

Adapt working practices to hybrid model expectations by managing tasks effectively both onsite and remote sustaining productivity and availability while delivering consistent claim outcomes

Qualifications

Possess professional experience of two to four years in commercial claims handling within the health care domain demonstrating practical exposure to end to end claim processing life cycles

Apply strong working knowledge of health care products including benefits structures cost sharing rules and exclusions to interpret complex claim scenarios with precision

Demonstrate proficiency in commercial claims adjudication using claim processing platforms and standard office productivity tools to support detailed analysis and documentation activities

Communicate fluently in English for reading writing and speaking to collaborate with colleagues document decisions and explain claim outcomes to relevant stakeholders

Show familiarity with common regulatory and compliance expectations in health care claims such as documentation standards and audit readiness to support risk aware processing

Utilize analytical thinking and problem solving skills to investigate claim anomalies and recommend targeted corrective actions that improve accuracy and reduce rework

Exhibit adaptability to hybrid work arrangements and day shift schedules by organizing workload efficiently and maintaining consistent focus on quality and turnaround expectations

Certifications Required

Preferred certifications include medical coding or health insurance related credentials such as CPC or AHIP health care.

À savoir avant de postuler

Autorisation de travail: Cognizant ne prendra en considération que les candidats à ce poste qui sont légalement autorisés à travailler au Canada sans avoir besoin d'un parrainage de l'employeur, aujourd'hui ou à l'avenir.
Mesures d’adaptation: Si vous avez un handicap qui nécessite des mesures d’adaptation raisonnable pour effectuer une recherche d’emploi ou poser une candidature, veuillez envoyer un courriel à [email protected] avec votre demande et vos coordonnées.
L’IA dans notre processus de recrutement: Nous utilisons des outils d'intelligence artificielle (IA) pour trier et évaluer les candidatures efficacement. Notre équipe examine ensuite les candidatures et décide qui passe à l’étape suivante.
Poste à pourvoir: Sauf indication contraire, ce poste est actuellement vacant et nous cherchons à le pourvoir.
Exigences linguistiques: Nous demandons à tous les candidats de posséder une connaissance de base de l’anglais afin de faciliter les communications internes. Pour les postes au Québec, la capacité à communiquer efficacement en anglais est requise car vous fournirez des services à et collaborerez avec des parties prenantes anglophones situées hors de la province.
Inclusion: Cognizant est un employeur souscrivant au principe de l’égalité d’accès à l’emploi. Votre candidature et votre dossier ne seront pas examinés en fonction de la race, de la couleur, du sexe, de la religion, des croyances, de l'orientation sexuelle, de l'identité de genre, de l'origine nationale, du handicap, des renseignements génétiques, de la grossesse, du statut d'ancien combattant ou de toute autre caractéristique protégée par les lois fédérales, provinciales ou locales.

À propos de Cognizant
Cognizant (NASDAQ: CTSH) est un AI Builder et une entreprise de services numériques (ESN) élaborant des solutions complètes d’IA maximisant les investissements pour des résultats concrets. Sa profonde expertise des métiers, des processus et des technologies lui permet d’intégrer dans les systèmes technologiques le contexte unique de chaque organisation de l’ingénierie à la production à l’échelle. Son objectif: améliorer l’efficacité des équipes, créer de la valeur et permettre aux grandes entreprises de rester performantes dans un monde qui évolue rapidement. Pour en savoir plus: cognizant.ai ou @cognizant.