Claims Examiner

Are you ready for an exciting work-from-home Claims Examining position? Then we want to talk to you!

Cognizant, a global IT consulting firm committed to engineering excellence, is looking for dynamic Medical Claims Examiners for remote opportunities to review claim submissions, verify information, adjudicate the claim as per claim processing guidelines to ensure appropriate payment or denial as per the business requirements.

Here is an overview of what a day in the life of our Claims Examiners looks like

• Examining and entering basic claims for appropriateness of care and completeness of information in accordance with industry 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 using 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 efficiency 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

• Examiners may be asked to work overtime when the business need requires

Here is what you should bring to the table:

• Education: High School diploma or GED required.

• Experience: Minium of one to three years of Medicaid and or commercial claims payer processing experience.

Technical competencies include

• Comfortable working independently

• Good interpersonal, time management, attention to detail, and organizational skills

• Good oral/written communication and analytical skills

• Comfortable 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)

• Proficient in Microsoft Office – Excel, Word, and Outlook

What's in it for you? We offer a competitive pay rate and excellent benefit package that includes healthcare insurance that, if chosen, goes into effect from day one of employment, generous paid holidays and PTO and many other benefits.

Cognizant regularly is recognized as an inclusive environment embracing diversity: for the second time, Cognizant has been named to the Forbes list of Best Employers for Diversity based on survey responses from its employees! We embrace the diversity of our Team and welcome everyone.

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.

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

Hourly Rate and Other Compensation:

The hourly rate for this position is between $16.88– $19.62 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

We are accepting applications through February 9, 2024.

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. 

Employee Status : Full Time Employee

Shift : Day Job

Travel : No

Job Posting : Jan 25 2024

About Cognizant

Cognizant (Nasdaq-100: CTSH) is one of the world's leading professional services companies, transforming clients' business, operating and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build and run more innovative and efficient businesses. Headquartered in the U.S., Cognizant is ranked 185 on the Fortune 500 and is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com or follow us @USJobsCognizant.

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.

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.