Medical Claims Processor (Remote)

Join Our Team at Cognizant: Pioneering Solutions, Transforming Futures

At Cognizant, we're not just about technology; we're about pioneering solutions that create meaningful transformations. We're looking for innovative minds, problem-solvers who are passionate about making a difference in the fast-paced world of technology. If you're ready to challenge the status quo and drive excellence, we want you on our team.

Purpose

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.

Essential Functions

• Examining and entering basic claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met
• Processing claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit
• Approving, pending, or denying payment according to the accepted coverage guidelines
• Follows all team procedures, including HIPAA policies and procedures, and meets team quality, turnaround time and productivity performance standards and goals
• Identifying and referring all claims with potential third party liability (i.e.,. subrogation, COB, MVA, stop loss claims, and potential stop loss files)
• Maintaining 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 updating information to 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
  
  

Qualifications

Education: High School diploma or GED required.

Experience: Minium of two-three years of Medicaid and or Commercial claims payer processing experience.

Technical Compentencies

• 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
• Healthacre claims payer processing experience (required)
• Ability to work in a high pace while maintaining quality and productivity targets
  
  

Working Enviornment Requirement

• Ability to work remotely in a secure environment (required)
• Must have high-speed internet connection (required)
• Must have highs-speed internet modem with ability to connect laptop to wired connection port (Required)
• Must have a workspace and location free from distractions and safety of healthcare data (required)
  
  

Location: Fully Remote

Salary And Other Compensation

The hourly rate for this position is $17-$18.55, dependent 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.

Applications will be accepted until June 28th, 2024.

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 salary, 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 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

If you have a disability that requires a reasonable accommodation to search for a job opening or submit an application, please email CareersNA2@cognizant.com with your request and contact information. Applications are accepted on an ongoing basis.

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 345,000 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-100: CTSH) is one of the world's leading professional services companies, helping organizations modernize technology, reimagine processes and transform experiences, so they stay ahead in a fast-changing world.

Our Commitment To Diversity And Inclusion

Cognizant is an equal opportunity employer that embraces diversity, champions equity and values inclusion. We are dedicated to nurturing a community where everyone feels heard, accepted and welcome. 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 protected characteristic as outlined by federal, state or local laws.

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.