Claims Process Executive (remote)

Cognizant; Des Moines (IA); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading technology services company is seeking a Claims Process Executive to handle remote claims processing. The successful candidate will review claims for completeness and adhere to required guidelines. Applicants should have a high school diploma and experience in Medicaid or Commercial claims. This position offers a salary between $17.00 - $20.00 per hour, depending on experience, along with comprehensive benefits.

Benefits

Medical/Dental/Vision/Life Insurance

Paid Time Off and holidays

401(k) plan and contributions

Employee Stock Purchase Plan

Qualifications

• Minimum of two-three years of Medicaid and/or Commercial claims payer processing experience.
• Knowledge of medical terminology and billing guidelines required.
• Ability to work independently in a high-performance environment.

Responsibilities

• Examine and enter claims for appropriateness and completeness.
• Process claims for multiple plans according to guidelines.
• Maintain internal customer relations regarding claims issues.

Skills

Attention to detail

Interpersonal skills

Time management

Communication skills

Analytical skills

Education

High School diploma or GED

Tools

FACETS

Microsoft Office (Excel, Word, Outlook)

Job description

Overview

Claims Process Executive (remote)

Responsibilities

• 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: Minimum of two-three years of Medicaid and/or Commercial 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 at a high pace while maintaining quality and productivity targets

Working Environment

• Ability to work remotely in a secure environment (required)
• Must have a high-speed internet connection (required)
• Must have high-speed internet modem with the ability to connect laptop to a 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 October 10th, 2025.

The annual salary for this position is between $17.00 - $20.00 depending on the experience and other qualifications of the successful candidate.

This position is also eligible for Cognizant’s discretionary annual incentive program and stock awards, 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

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.