About the Job
Cognizant is seeking dynamic Medical Claims Examiners for remote opportunities to review claim submissions, verify information, and adjudicate claims according to processing guidelines to ensure appropriate payment or denial. In this exciting work-from-home position, you will build on your existing skills while helping companies modernize technology, reimagine processes, and transform experiences in a fast-changing world.
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A typical day in the life of a Claims Examiner includes:
- Examining and entering claims for appropriateness of care and completeness of information in accordance with industry guidelines, ensuring compliance with government and state regulations
- Processing claims for multiple plans, determining the appropriate payment for specific benefits
- Approving, pending, or denying payments based on accepted coverage guidelines
- Following team procedures, including HIPAA policies, while meeting quality, turnaround time, and efficiency performance standards
- Identifying and referring claims with potential third-party liability (e.g., subrogation, COB, MVA)
- Maintaining internal customer relations by interacting with staff regarding claims issues, ensuring accurate and complete claim information
- Contacting insured or other involved parties for additional or missing information
- Assisting with overtime when business needs require
Requirements
- Education: High School diploma or equivalent required
- Experience: Minimum of one to three years of Medicaid and/or commercial claims payer processing experience
Technical Proficiencies
- Comfortable working independently
- Good interpersonal, time management, attention to detail, and organizational skills
- Strong oral and written communication skills
- Ability to analyze information effectively
- Experience navigating multiple systems using dual monitors
- Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA, and UB92 Codes, and standard billing guidelines required
- FACETS experience (highly preferred)
- Medicaid knowledge (required)
- Proficient in Microsoft Office – Excel, Word, Outlook
Compensation and Benefits
- Hourly Rate: $16.88–$19.62 per hour, depending on experience and qualifications
- Eligible for Cognizant’s discretionary annual incentive program, based on performance
- Benefits include:
- 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
Cognizant celebrates diversity and is committed to creating an inclusive environment. We encourage applicants from all backgrounds to apply.
