Job Title: SPE – Claims HC
Location: [Not specified]
Employment Type: Full-time
Work Model: Remote / Hybrid (based on role requirement)
Job Category: Healthcare & Claims
Visual Theme: Blue and white swirls
Job Summary
Cognizant is seeking a skilled and detail-oriented professional to join our team as an SPE – Claims HC, focusing on Clinical Claims Review. The ideal candidate will bring clinical expertise and operational acumen to ensure accuracy, compliance, and efficiency in the claims adjudication process.
Key Responsibilities
Manage the claims adjudication process to ensure compliance with internal guidelines and industry standards.
Provide domain expertise in claims and payer operations to drive process optimization.
Analyze claims data to identify trends, inefficiencies, and improvement areas.
Collaborate with cross-functional teams to streamline workflows and improve claims turnaround times.
Ensure timely resolution of claims issues to maintain a high level of customer satisfaction.
Design and implement process improvements for enhanced claims adjudication.
Monitor and report performance metrics to ensure alignment with Service Level Agreements (SLAs).
Serve as a point of contact for stakeholders to resolve claims-related inquiries.
Apply technical and clinical knowledge to troubleshoot complex claims issues.
Stay updated with industry regulations and best practices.
Contribute to the development of training materials and SOPs for the claims team.
Support and drive continuous improvement initiatives in claims operations.
Maintain accurate documentation and prepare reports for management review.
Required Qualifications
Bachelor’s degree in Nursing (B.Sc. Nursing).
Minimum 2+ years of clinical experience.
Strong analytical skills to evaluate data and recommend improvements.
Demonstrated expertise in claims adjudication processes and techniques.
Sound understanding of payer domain requirements and healthcare regulations.
Ability to work independently in a remote or hybrid setting.
Excellent communication and interpersonal skills.
High attention to detail and problem-solving abilities.
Preferred Skills
Experience with healthcare payer systems or claims processing tools.
Exposure to U.S. healthcare regulations (e.g., HIPAA, CMS, ICD/CPT codes) is a plus.
Certifications
B.Sc. Nursing (Mandatory)
Clinical experience of at least 2 years required.
About Cognizant
Cognizant is one of the world’s leading professional services companies, helping clients transform their business, operating, and technology models for the digital age. We provide solutions that are consultative, industry-focused, and technology-driven to help our clients stay ahead in a rapidly changing world.
🌐 Learn more: www.cognizant.com
Our Culture
Be part of a high-caliber, collaborative, and inclusive global community.
Thrive in an environment where innovation, care, and ethics are core values.
Join a company that puts people, clients, communities, and the planet at the heart of its mission.
Work for a NASDAQ-100 company named as one of Forbes World’s Best Employers 2024.
Equal Opportunity Employer
Cognizant is an Equal Opportunity Employer, committed to building a diverse workforce. We do not discriminate based on:
Race, color, or religion
Sex, gender identity or expression
Sexual orientation
National origin or ancestry
Disability or genetic information
Pregnancy, veteran status, or other protected characteristics
Accessibility Accommodation
If you require reasonable accommodation due to a disability during the job search or application process, please contact:
📧 CareersNA2@cognizant.com
Additional Information
Compensation information is accurate as of the posting date and may be modified in accordance with applicable laws.
Applicants may be asked to attend interviews in person or via video conference.
Government-issued ID may be required during the interview process.
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