Claims Quality Review (remote)

Cognizant; Santa Fe (NM); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare solutions provider is seeking individuals for a remote Claims Quality Review position. Ideal candidates will have a high school diploma and at least five years of healthcare claims processing experience, along with strong communication and coaching skills. The role involves monitoring transactions and ensuring adherence to quality standards. Competitive hourly rate plus benefits are offered. Applications accepted until October 13th, 2025.

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 3 years QA Experience.
• Minimum of 5 years Healthcare claims processing experience.

Responsibilities

• Monitor and evaluate transactions against quality assurance standards.
• Participate in calibration sessions and communication sessions.
• Conduct coaching and feedback sessions as needed.
• Provide accurate and timely reports on quality metrics.

Skills

Good Spoken & Written English

Communication Skills

Coaching (Soft) skills

Excel knowledge on charts & tables

Attention to detail

Integrity and Ethical Behavior

Education

High school Diploma

Tools

MS Office applications

Job description

Overview

Claims Quality Review (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.

This position requires individuals to perform the following duties and work as part of a team:

Responsibilities

• Monitor, evaluate and score transactions against established quality assurance instruments and standards
• Participate, as needed, in calibration sessions, communication sessions, and/or creation of communication tools
• Supports and communicates business goals, quality standards, processes and procedures and policies
• Ensures the claims processing reps adhere to predetermined quality assurance standards and the business’s standard operating procedures, serves as Subject Matter Expert
• Conduct coaching and feedback sessions as needed
• 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
• Ability to work overtime and/or a flexible schedule based on business, client and/or accounting needs
• Other duties as assigned

Qualifications

• High school Diploma - REQUIRED

• Minimum of one (3) years QA Experience

• Minimum of one (5) years Healthcare claims processing experience

• Good Spoken & Written English Good Communication Skills

• Coaching (Soft) 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

The hourly rate for this position is between $19.00 – 20.00 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.

Applications will be accepted until October 13th, 2025.

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.

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.