Job Summary
Role focuses on managing health care product operations and denial processing workflows in a hybrid night shift environment ensuring accurate claim handling issue resolution and continuous improvement for global stakeholders while maintaining strong quality standards and contributing to better patient and provider outcomes through efficient back office support.
Responsibilities
Manage daily work queues for health care product related cases and denial processing items to ensure timely resolution and adherence to agreed service levels for internal and external stakeholders.Analyze denial trends across multiple health care product lines and identify actionable insights that support reduction of repeat issues and improvement of payment accuracy.Coordinate with cross functional teams including operations quality and product support to clarify complex denial scenarios and ensure consistent application of rules and guidelines.Review claim and denial documentation with strong attention to detail to validate required information and minimize processing errors that impact members and providers.Maintain up to date knowledge of health care product features benefit structures and denial categories in order to apply correct decision logic during night shift operations.Document case handling steps root causes and resolutions in workflow tools to enable transparent reporting and support future audits and continuous improvement initiatives.Support implementation of process changes and system enhancements related to denial processing by providing practical feedback based on day to day case management experience.Provide clear written communication in standard templates to internal teams regarding denial outcomes required actions and escalations ensuring professional and neutral language at all times.Monitor individual productivity and quality metrics during hybrid work arrangements and proactively adjust work patterns to meet both performance expectations and compliance norms.Escalate unusual patterns such as potential system defects or policy ambiguities that influence multiple denial cases and collaborate with designated teams to drive timely corrective actions.Contribute to training refreshers by sharing case examples and best practices that help colleagues handle complex health care product denials more efficiently and consistently.Adhere strictly to company compliance requirements including data privacy and regulatory guidelines while processing sensitive health care information in night shift schedules.Support the organizations broader purpose by helping reduce administrative burden for providers and members through accurate efficient denial management that improves trust in health care services.
Qualifications
Demonstrate hands on experience working with health care products and related operational processes over at least two years with clear understanding of benefit rules and claim flows.Apply specialized knowledge in denial processing including categorization root cause identification and corrective action planning in alignment with standard operating procedures.Utilize analytical skills to interpret denial metrics spot recurring issues and recommend targeted improvements that enhance operational efficiency and service quality.Communicate effectively in written and verbal forms to collaborate with global teams during night shift operations while maintaining professional tone and clarity.Operate comfortably in a hybrid work model using enterprise workflow tools communication platforms and reporting dashboards to manage tasks and share updates.Follow structured problem solving approaches and display resilience in handling high volume denial workloads within tight timelines without compromising accuracy.
Sobre a Cognizant
Cognizant (NASDAQ: CTSH) é uma construtora de IA e fornecedora de serviços de tecnologia, criando a ponte entre o investimento em IA e o valor para as empresas por meio do desenvolvimento de soluções de IA completas para nossos clientes. Nossa profunda experiência em setores, processos e engenharia nos permite incorporar o contexto único de cada organização em sistemas tecnológicos que potencializam a capacidade humana, geram resultados tangíveis e mantêm empresas globais à frente em um mundo em rápida transformação. Saiba mais em cognizant.ai ou @cognizant.
A Cognizant é uma empregadora que investe em equidade. Sua candidatura não será pautada em raça, cor, gênero, sexualidade, credo, origem, deficiência, gravidez ou qualquer outra característica protegida pelas leis brasileiras.
Informações adicionais de emprego
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Embora nosso sistema permita a candidatura em todos os idiomas, o(s) idioma(s) e o(s) nível(is) de proficiência exigidos para o trabalho variam. No entanto, é necessário um nível básico de inglês para fins de comunicação em toda a empresa.
A Cognizant é uma empregadora que investe em equidade. Sua candidatura não será pautada em raça, cor, gênero, sexualidade, credo, origem, deficiência, gravidez ou qualquer outra característica protegida pelas leis brasileiras.
Se você tem uma deficiência que requer adaptações razoáveis para procurar uma vaga de emprego ou enviar uma candidatura, envie um e-mail para [email protected] com sua solicitação e informações de contato.
