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Claims Examiner (remote)

Cognizant

Phoenix (AZ)

Remote

USD 10,000 - 60,000

Full time

10 days ago

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Job summary

Cognizant is hiring a Claims Examiner for a remote position in Phoenix, AZ. The role involves processing and reviewing claims submissions to ensure accurate payments. Ideal candidates will have a high school diploma, relevant experience in claims processing, and strong attention to detail. This full-time position offers competitive hourly pay and benefits, such as medical insurance and paid time off.

Benefits

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

Qualifications

Minimum of two to three years of claims payer processing experience required.
Knowledge of medical terminology, CPT-4, ICD-9, ICD-10 required.
FACETS experience highly preferred.

Responsibilities

Review claim submissions and verify information.
Approve, pending, or deny payment according to guidelines.
Interact with staff regarding claims issues.

Skills

Attention to detail

Interpersonal skills

Time management

Analytical skills

Education

High School diploma or GED

Tools

Microsoft Office – Excel, Word, Outlook

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Claims Examiner (remote)

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

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 regularly 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 to three years of Medicaid and or Commerical claims payer processing experience.

Technical Competencies

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

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)

Salary And Other Compensation

Applications will be accepted until May 31, 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.

Seniority level

Seniority level
Entry level

Employment type

Employment type
Full-time

Job function

Job function
Finance and Sales
Industries
IT Services and IT Consulting and Business Consulting and Services

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