Remote Provider Appeals Analyst

Cognizant; Olympia (WA); On-site; USD 25,000 - 26,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Paid Holidays & PTO

401(k) Plan

Employee Stock Purchase Plan

Discretionary annual incentive

Job summary

Cognizant is seeking a Provider Appeals Specialist to review, research, process, and resolve provider appeals related to claims payment, reimbursement disputes, authorization denials, and contractual issues. This is a remote role for candidates who live in the United States.

You will collaborate with healthcare providers, payer organizations, and internal teams to ensure appeals are handled accurately, timely, and in compliance with regulatory requirements, HIPAA, and Cognizant policies.

Qualifications

• High school diploma or equivalent required; higher degree preferred.
• 2+ years of experience in healthcare claims, provider services, appeals, billing, or related healthcare operations.
• Knowledge of medical terminology, healthcare claims processing, reimbursement methodologies, payer guidelines.
• Understanding of CMS regulations, commercial insurance guidelines, and healthcare compliance standards.
• Experience with healthcare claims management systems and Microsoft Office.
• Strong analytical, problem-solving, and investigative skills.
• Excellent written and verbal communication.
• Ability to manage multiple priorities and meet deadlines.

Responsibilities

• Review and investigate provider appeals related to denied, adjusted, or underpaid claims.
• Analyze claim histories, medical records, and contracts to determine outcomes.
• Interpret provider agreements, reimbursement methodologies, and payer rules.
• Research root causes of disputes and identify corrective actions.
• Ensure HIPAA-compliant notifications and timely appeals processing.
• Collaborate with cross-functional teams to resolve complex cases.
• Maintain documentation in applicable systems and databases.
• Escalate high-risk appeals to leadership when appropriate.
• Monitor trends and propose process improvements.
• Support quality audits, regulatory reviews, and training.

Skills

Analytical skills

Problem solving

Investigative skills

Written communication

Verbal communication

Time management

Attention to detail

Regulatory compliance

Customer service

Cross-functional collaboration

Education

High school diploma

Associate's or Bachelor's degree preferred

Tools

Microsoft Office

Job description

Cognizant is seeking a Provider Appeals Specialist to review, research, process, and resolve provider appeals related to claims payment, reimbursement disputes, authorization denials, and contractual issues. This is a remote role for candidates who live in the United States.

You will collaborate with healthcare providers, payer organizations, and internal teams to ensure appeals are handled accurately, timely, and in compliance with regulatory requirements, HIPAA, and Cognizant policies.