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SME-Claims HC

00068707541



Job Summary

This role involves providing specialized expertise in claims adjudication within the healthcare domain. The candidate will work from the office during night shifts ensuring accurate and efficient claims processing. The position requires a minimum of 2 years and a maximum of 4 years of relevant experience with a focus on delivering high-quality outcomes.


Responsibilities

  • Analyze and process healthcare claims with precision ensuring compliance with adjudication guidelines and policies.
  • Collaborate with internal teams to resolve discrepancies and ensure seamless claims adjudication workflows.
  • Monitor claims data for accuracy and identify patterns or anomalies that may require further investigation.
  • Utilize technical expertise in claims adjudication to optimize processing times and reduce errors.
  • Provide detailed documentation and reports on adjudicated claims for auditing and review purposes.
  • Ensure adherence to regulatory requirements and company standards in all claims processing activities.
  • Communicate effectively with stakeholders to address queries and provide clarifications regarding claims adjudication.
  • Stay updated on industry trends and changes in healthcare claims policies to maintain expertise in the domain.
  • Support the implementation of process improvements to enhance efficiency and accuracy in claims adjudication.
  • Participate in training sessions and knowledge-sharing initiatives to strengthen team capabilities.
  • Leverage domain skills in commercial claims payer systems and claims management to deliver impactful results.
  • Contribute to the companys mission by ensuring timely and accurate processing of claims positively impacting customer satisfaction.
  • Maintain confidentiality and integrity in handling sensitive healthcare claims data. Qualifications
  • Demonstrate proficiency in claims adjudication processes and possess hands-on experience in healthcare claims systems.
  • Exhibit strong analytical skills to identify and resolve issues in claims processing efficiently.
  • Showcase familiarity with commercial claims payer systems and claims management as a nice-to-have domain expertise.
  • Display excellent communication skills to interact effectively with stakeholders and team members.
  • Possess a detail-oriented mindset to ensure accuracy and compliance in all adjudication tasks.
  • Show adaptability to work in night shifts and deliver consistent performance in a dynamic environment.
  • Highlight a commitment to continuous learning and staying updated on industry standards and best practices.

    • Certifications Required

    Certified Professional Coder (CPC) Certified Claims Specialist (CCS)

    The Cognizant community:
    We are a high caliber team who appreciate and support one another. Our people uphold an energetic, collaborative and inclusive workplace where everyone can thrive.

    • Cognizant is a global community with more than 300,000 associates around the world.
    • We don’t just dream of a better way – we make it happen.
    • We take care of our people, clients, company, communities and climate by doing what’s right.
    • We foster an innovative environment where you can build the career path that’s right for you.

    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.

    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, state 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.

    Disclaimer:
    Compensation information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.

    Applicants may be required to attend interviews in person or by video conference. In addition, candidates may be required to present their current state or government issued ID during each interview.

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