Claims Processor - Remote

Cognizant is a large IT Consulting Firm that leverages modern technologies to improve a variety of business operations. As our team continues to grow, we are currently looking to hire additional Claims Processors. This role is fully remote, and all candidates must reside in the United States. Claim processors will review claim submissions, verify information, adjudicate the claim as per claim processing guidelines to ensure appropriate payment or denial as per the business requirements.

Role Responsibilities

• Examine and enter basic claims for appropriateness of care and completeness of information in accordance with the accepted coverage guidelines, ensuring that all mandated government and state regulations are consistently met
• Process claims for multiple plans with automated and manual differences in benefits, as well as use the system and written documentation to determine the appropriate payment for a specific benefit
• Approve pending or denying payment according to the accepted coverage guidelines
• Follow all team procedures, including HIPAA policies and procedures, and meet team quality, turnaround time and efficiency performance standards and goals
• Identify and refer all claims with potential third party liability (i.e.,. subrogation, COB, MVA, stop loss claims, and potential stop loss files)
• Maintain internal customer relations by interacting with staff regarding claims issues and research, ensuring accurate and complete claim information, contacting insured or other involved parties for additional or missing information, and update information to the claim file with regard to claims status, questions, or claim payments
• Other duties as assigned
• Must be willing to work overtime when the business need requires

Desired Skills & Experience

• Must have at least a High School diploma or GED.
• Must have a minimum of 2-3 years of Medicaid and or Commercial claims payer processing experience.
• Ability to work independently
• Strong attention to detail
• Strong interpersonal, time management, and organizational skills
• Good oral/written communication and analytical skills
• Must be able to work in a high performance environment that changes often
• Experience in navigating multiple systems using dual monitors
• Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92 Codes, and standard of billing guidelines required.
• FACETS experience (highly preferred)
• Medicaid knowledge (required)
• Keyboard skills of at least 35 WPM + 10-key
• Proficient in Microsoft Office - Excel, Word, and Outlook
• Healthcare claims payer processing experience (required)
• Ability to work in a high pace while maintaining quality and productivity targets
• Working Environment Requirement:
• Ability to work remotely in a secure environment (required)
• Must have a high-speed internet connection (required)
• Must have high-speed internet modem with the ability to connect your laptop to a wired connection port (Required)
• Must have a workspace and location free from distractions and safety of healthcare data (required)

Salary and Other Compensation:
Applications will be accepted until February 14th, 2025.

The hourly rate for this position is between $18.00 - $19.00 per hour, depending on experience and other qualifications of the successful candidate.

This position is also eligible for Cognizant's discretionary annual incentive program, based on performance and subject to the terms of Cognizant's applicable plans.

Benefits: Cognizant offers the following benefits for this position, subject to applicable eligibility requirements:

• Medical/Dental/Vision/Life Insurance
• Paid holidays plus Paid Time Off
• 401(k) plan and contributions
• Long-term/Short-term Disability
• Paid Parental Leave
• Employee Stock Purchase Plan

Disclaimer: The hourly rate, other compensation, and benefits 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.

Cognizant will only consider applicants for this position who are legally authorized to work in the United States without requiring company sponsorship now or at any time in the future.