Medical Claims Processor - Remote

Cognizant; Columbia (SC); Remote; USD 10,000 - 60,000; Full time

Job summary

A leading IT consulting firm is seeking a Fully Remote Medical Claims Processor to manage and adjudicate claims accurately. Candidates must have a High School diploma and at least 1 year of medical claims processing experience. Knowledge of coding and the ability to work independently is essential. The role offers an hourly rate of $15.20 – $17.75, with a comprehensive benefits package including 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

• At least 1 year of medical claims processing experience required.
• Experience with UB and/or professional claims is necessary.
• Knowledge of CPT, HCPCS, ICD-9 coding is required.

Responsibilities

• Review data in the claim processing system and compare with corresponding information.
• Ensure tasks are handled within timeframes to meet SLAs.
• Work closely with other departments on claims issues.

Skills

Medical claims processing

Problem-solving skills

Knowledge of medical terminology

Attention to detail

Basic Microsoft Excel skills

Education

High School Diploma or equivalent

Tools

Facets

Job description

Cognizant is a large IT Consulting Firm that leverages modern technologies to transform a variety of business operations. We are seeking Fully Remote US Based Claims Processors to join our growing team. The Medical Claims Processor is responsible for the timely and accurate adjudication of professional and hospital claims utilizing payer specific policies and procedures. Provide support to claims and client for issues related to claims adjudication and adjustments, Service Now and Inquiry resolution, and any basic questions regarding health coverage as stated in the Plan Document.

Role Responsibilities

• Responsible for reviewing the data in the claim processing system (Facets) and comparing it with the corresponding UB, HCFA paper, or EDI information.

• Responsible for reviewing medical records when necessary to determine if the service rendered was medically appropriate and criteria has been met.

• Responsible for reviewing claim and line item edits and warning messages for determination of whether to pay claim/line item(s).

• Ensure that all designated tasks are handled within the appropriate timeframe in order to meet internal and external SLAs

• Assigned special projects or other duties as determined by management.

• Will work closely with other departments

Desired Qualifications

• At least a High School Diploma or equivalent is required

• A minimum of 1 years of medical claims processing is required

• Facets experience is highly preferred

• Knowledge of physician practice and hospital coding, billing, and medical terminology, CPT, HCPCS, ICD-9

• Experience with UB/institutional (CMS-1450) and/or professional (CMS 1500) claims

• Knowledge of Medicare billing & payment and coverage guidelines and regulations

• Experience in the analysis and processing of claims, utilization review/quality assurance procedures

• Must be able to work with minimal supervision.

• Creative thinker with good problem-solving skills specifically related to healthcare claim adjudication

• Possess the ability to work at a computer for extended periods.

• Must have basic Microsoft Excel skills

Salary and Other Compensation

Applications will be accepted until October 17th, 2025.

The hourly rate for this position is between $15.20 – $17.75 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

• 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 will only consider applicants for this position who are legally authorized to work in the United States without requiring company sponsorship now or at any time in the future.

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.