Claims Auditor (remote)

Cognizant; Sacramento (CA); Remote; USD 100,000 - 125,000; Full time

Job summary

A leading consulting firm is seeking a Claims Auditor to work remotely. Responsibilities include monitoring claims, verifying data, and ensuring compliance with guidelines. Successful applicants should have at least two years of healthcare claims processing experience and strong communication skills. The hourly rate ranges from $18.00 to $19.00, depending on experience, with additional benefits available.

Benefits

Medical/Dental/Vision/Life Insurance

401(k) plan and contributions

Paid holidays plus Paid Time Off

Paid Parental Leave

Employee Stock Purchase Plan

Qualifications

• Minimum one (1) year QA Experience.
• Minimum of two (2) years Healthcare claims processing experience.
• High Level of Integrity and Ethical Behavior.

Responsibilities

• Monitor, evaluate and score claims against established quality assurance standards.
• Verify if processed claims have all data updated according to coverage guidelines.
• Process claims for multiple plans with manual and automated differences.

Skills

Good Spoken & Written English

Attention to detail

Excel knowledge on charts & tables

Communication Skills

Education

Highschool Diploma

Tools

MS Office applications

Job description

Overview

Claims Auditor (remote)

This is a remote position open to any qualified applicant that lives in the United States.

Summary:

Our Cognizant leadership team, working with our client, is currently seeking individuals to perform the following duties and work as part of our established claims adjudication team. We are seeking highly motivated healthcare professionals with auditing experience in professional claims adjudication area. Absences will not be permitted during training-approximately 6 weeks. This is a work-from-home position with day hours, and no travel is required.

Responsibilities

• Monitor, evaluate and score claims against established quality assurance instruments and standards

• Verifying if the processed claims have all data updated 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

• Validating if the claims are approved/ denied 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

• Validating if 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 about claims status, questions or claim payments

• Must be willing to work overtime when the business need requires

• Provides accurate and timely reports on a daily, monthly, month-to-date and year-to-date rolling basis on quality, productivity, availability and other key metrics as determined

Qualifications

• Highschool Diploma - REQUIRED

• Minimum one (1) year QA Experience

• Minimum of two (2) year Healthcare claims processing experience

• Good Spoken & Written English Good Communication Skills

• Excel knowledge on charts & tables Knowledge on MS Office applications

• High Attention to detail

• High Level of Integrity and Ethical Behavior

Salary and Other Compensation

Applications will be accepted until October 13th, 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.

Cog2025

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.