Claims Process Specialist (Remote)
Job Purpose:
Claim Processors will review claim submissions, verify information, and adjudicate claims in alignment with claim processing guidelines to ensure accurate payment or denial based on business requirements.
Essential Functions:
Examine and enter basic claims to ensure appropriateness of care and completeness in accordance with accepted coverage guidelines and regulatory compliance.
Process claims for various plans, using both automated and manual benefit differences to determine appropriate payment.
Approve, pend, or deny payment per accepted guidelines.
Adhere to team procedures, HIPAA policies, and meet performance standards for quality, turnaround time, and productivity.
Identify and refer claims with potential third-party liability such as subrogation, COB, MVA, stop loss, etc.
Maintain internal communication by interacting with staff regarding claims issues, conducting research, and contacting involved parties for additional information.
Update claim files with current status, inquiries, or payment decisions.
Perform other duties as assigned.
Be available to work overtime based on business needs.
Qualifications:
Education: High School diploma or GED (required).
Experience:
2–3 years of experience in Medicaid and/or commercial claims payer processing (required).
FACETS experience (highly preferred).
Medicaid knowledge (required).
Experience in healthcare claims payer processing (required).
Technical Competencies:
Ability to work independently and remotely.
Strong attention to detail and organizational skills.
Proficiency in oral/written communication and analytical abilities.
Adaptability to a fast-paced and frequently changing environment.
Dual monitor system navigation.
Familiarity with medical terminology and billing codes (CPT-4, ICD-9, ICD-10, HCPCS, ASA, UB92).
Keyboarding speed of at least 35 WPM + 10-key.
Proficient in Microsoft Office (Excel, Word, Outlook).
Working Environment Requirements:
Secure remote work environment (required).
High-speed internet with a wired modem connection (required).
Distraction-free and safe workspace (required).
Compensation:
Salary Range: $17.00 – $20.00 per hour, based on experience and qualifications.
Application Deadline: May 29th, 2025.
Eligible for Cognizant’s discretionary annual incentive and stock award programs.
Benefits:
Medical, Dental, Vision, and Life Insurance
Paid Time Off and Holidays
401(k) with company contributions
Long-term and Short-term Disability
Paid Parental Leave
Employee Stock Purchase Plan
About Cognizant:
Cognizant is a leading professional services company transforming business, operating, and technology models for the digital era. We are home to over 300,000 associates globally, dedicated to doing what's right—for people, clients, communities, and the environment. Learn more at www.cognizant.com.
Equal Opportunity Employer Statement:
Cognizant is an equal opportunity employer and does not discriminate against any employee or applicant based on legally protected characteristics.
Accommodation Requests:
If you need accommodation to apply, email CareersNA2@cognizant.com with your request and contact details.
Interview Process:
Applicants may need to attend interviews virtually or in person and show valid state or government ID during each stage.
Job Details:
Job Number: 00063816663
Category: Business Processes
Location: Phoenix, AZ – N Norterra Pkwy / United States
Employment Type: Full-time
Work Model: Remote
Date Published: April 29, 2025
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