Medical Claims Adjudication - remote

Cognizant is one of the world’s leading professional services companies, we help our clients modernize technology, reinvent processes, and transform experiences, so they can stay ahead in our constantly evolving world. We are looking to expand our team. Do you thrive in a busy environment and able to multi-task successfully? If so, please apply today!

The Claims Processor, you will ensure accurate and timely adjudication of professional and hospital claims utilizing payer specific policies and procedures. Provide support to claims and client issues related to claims adjudication and adjustments. Service Now and Inquiry resolution, and any basic questions regarding health coverage as stated in the employer’s plan document. You will be valued member of the Cognizant team and collaborate with stakeholders and other teams.

Primary Responsibilities:

• Review claim system data and verify against UB or HCFA paper or EDI information.
• Evaluate medical records to determine if the service rendered was medically appropriate and criteria compliance.
• Analyze claim and line-item edits, including warning messages, to determine payment eligibility.
• Manage all tasks within designated timeline to meet internal and external SLAs.
• Other duties as assigned by management.

Qualifications:

• A minimum of 2 years' claims processing experience is required.
• Knowledge of physician practice and hospital coding, and medical terminology, CPT, HCPCA, ICD-10
• Experience making payments with UB/institutional (CMS-1450) and/or professional (CMS 1500) claims.
• Knowledge of Medicare/Medicaid payment and coverage guidelines and regulations.
• Must be able to work with minimal supervision.
• 1 year of Facets experience.
• Experience in the analysis and processing of claims for payments, utilization review/quality assurance procedures.
• Excellent problem-solving skill in healthcare claims adjudication.
• Ability to work at a computer for extended periods.
• High School degree or GED or equivalent experience.

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.

Salary and Other Compensation:

Applications will be accepted until August 8, 2025

The hourly rate for this position is between $15.25 - $17.75 an 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.

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 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 (a member of the NASDAQ-100 and one of Forbes World’s Best Employers 2024) is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com

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.

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.