The Senior Process Executive will support Fraud, Waste & Abuse (FWA) activities through claims review, case analysis, and identification of potential irregularities within medical claims processing. The role requires strong claims knowledge, analytical thinking, attention to detail, and the ability to work independently in a fast-paced environment.
The successful candidate will undergo an accelerated training and capability-building programme of approximately 5.5 months before transitioning to full operational responsibilities."
Roles and Responsibilities:
· Review and analyse medical claims for potential Fraud, Waste & Abuse indicators
· Perform investigations on assigned FWA cases and document findings accurately.
· Conduct claim validation and identify irregular claim patterns or billing anomalies.
· Collaborate with internal stakeholders to obtain supporting information and clarify case details.
· Prepare case summaries, recommendations, and investigation outcomes in a timely manner.
· Ensure compliance with internal policies, operational procedures, and regulatory requirements.
· Meet productivity, quality, and turnaround time targets.
· Participate in continuous learning and FWA capability enhancement initiatives.
· Support ad-hoc projects and operational improvement activities as assigned.
Experience
1. Minimum -1-2 years of experience in medical claims processing, preferably in:
Outpatient (OP) Claims
Inpatient (IP) Claims
· Good understanding of healthcare claims adjudication and policy benefits.
· Strong analytical and problem-solving skills.
· High attention to detail and accuracy.
· Good written and verbal communication skills.
2. Senior Advisor - Minimum 3–5 years of experience in medical claims processing, preferably involving:
Outpatient (OP) Claims
Inpatient (IP) Claims
· Complex claims assessment or claims investigation
· Experience in quality review, coaching, or subject matter expertise is an added advantage.
· Demonstrated ability to work independently and manage complex cases.
· Strong stakeholder management and communication skills
· Self-disciplined and highly accountable.
· Demonstrates dedication and commitment to learning.
· Strong investigative mindset and critical thinking skills.
· Ability to handle confidential information with integrity.
· Adaptable and able to work under minimal supervision.
· Team player with a positive attitude and continuous improvement mindset.
Language: Must be Proficient in Cantonese (Written & Verbal)
About Cognizant:
Cognizant (Nasdaq: CTSH) engineers modern businesses. We help our clients modernize technology, reimagine processes and transform experiences so they can stay ahead in our fast-changing world. Together, we're improving everyday life. See how at www.cognizant.com or @cognizant.
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Acerca de Cognizant
Cognizant (Nasdaq: CTSH) es un creador de soluciones de IA y proveedor de servicios tecnológicos que conecta la inversión en IA con el valor empresarial mediante el desarrollo de soluciones de IA full‑stack para sus clientes. Su profundo conocimiento de la industria, junto con su experiencia en procesos e ingeniería, permite incorporar el contexto único de cada organización en sistemas tecnológicos que amplifican el potencial humano, generan resultados tangibles y mantienen a las empresas a la vanguardia en un entorno en constante cambio. Más información en cognizant.ai o @cognizant.
Información adicional sobre el empleo
La información sobre la compensación es exacta en la fecha de publicación de este anuncio. Cognizant se reserva el derecho de modificar esta información en cualquier momento, de conformidad con la legislación aplicable.
Es posible que se solicite a los solicitantes que asistan a entrevistas de forma presencial o mediante videoconferencia. Asimismo, durante cada entrevista, los candidatos podrán estar obligados a presentar un documento de identidad válido emitido por el estado o por el gobierno.
Cognizant es un empleador que ofrece igualdad de oportunidades. Su solicitud y candidatura no se evaluarán en función de la raza, el color, el sexo, la religión, el credo, la orientación sexual, la identidad de género, el origen nacional, la discapacidad, la información genética, el embarazo, la condición de veterano ni cualquier otra característica protegida por las leyes federales, estatales o locales.
