Claims Process Specialist (remote)

Cognizant; Arizona (TX); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Claims Process Executive to join their dynamic team. This remote role involves reviewing and processing claims, ensuring compliance with guidelines, and maintaining internal customer relations. The ideal candidate will have experience in Medicaid and/or Commercial claims processing, alongside strong attention to detail and excellent communication skills. If you are looking to make an impact in a supportive environment with opportunities for growth, this position is perfect for you.

Benefits

Health benefits

Incentives

Stock awards

Qualifications

• 2-3 years of claims processing experience, preferably in Medicaid.
• Strong attention to detail and ability to work independently.

Responsibilities

• Review and process claims for compliance and completeness.
• Approve or deny payments based on coverage guidelines.

Skills

Medicaid claims processing

Commercial claims processing

Attention to detail

Interpersonal skills

Organizational skills

Communication skills

Education

High School diploma or GED

Tools

Microsoft Office

FACETS

Job description

Join to apply for the Claims Process Executive (remote) role at Cognizant.

Job Purpose
Claim processors will review claim submissions, verify information, and adjudicate the claim according to processing guidelines to ensure appropriate payment or denial based on business requirements.

Essential Functions

1. Examine and enter claims for appropriateness of care and completeness, ensuring compliance with coverage guidelines and regulations.
2. Process claims for multiple plans, utilizing system and documentation to determine payment.
3. Approve, pend, or deny payments per coverage guidelines.
4. Follow team procedures, including HIPAA policies, and meet quality, turnaround, and productivity standards.
5. Identify and refer claims with potential third-party liability.
6. Maintain internal customer relations by interacting regarding claims issues, gathering information, and updating claim files.
7. Other duties as assigned.
8. Willingness to work overtime when needed.

Qualifications

• High School diploma or GED.
• 2-3 years of Medicaid and/or Commercial claims processing experience.

Technical Competencies

• Ability to work independently with strong attention to detail.
• Excellent interpersonal, organizational, and communication skills.
• Experience navigating multiple systems, knowledge of medical terminology, billing codes, and FACETS (preferred), Medicaid (required).
• Proficient in Microsoft Office, typing speed of 35 WPM + 10-key.

Working Environment

• Remote work capability in a secure environment.
• High-speed internet and wired connection.
• Distraction-free workspace.

Salary: $17.00 - $20.00/hour, with benefits, incentives, and stock awards. Applications accepted until May 29, 2025.