Claims Process Executive (remote)

Claims Process Executive (remote) JOB PURPOSE: Claim Processors will review claim submissions, verify information, adjudicate the claim as per claim processing guidelines to ensure appropriate payment or denial as per the business requirements. ESSENTIAL FUNCTIONS: • Examining and entering basic claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met • Processing claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit • Approving, pending, or denying payment according to the accepted coverage guidelines • Follows all team procedures, including HIPAA policies and procedures, and meets team quality, turnaround time and productivity performance standards and goals • Identifying and referring all claims with potential third-party liability (i.e., subrogation, COB, MVA, stop loss claims, and potential stop loss files) • Maintaining internal customer relations by interacting with staff regarding claims issues and research, ensuring accurate and complete claim information, contacting insured or other involved parties for additional or missing information, and updating information to claim file with regard to claims status, questions or claim payments • Other duties as assigned • Must be willing to work overtime when the business need requires QUALIFICATIONS: Education: High School diploma or GED required. Experience: Minium of two-three years of Medicaid and or Commercial claims payer processing experience. Technical Competencies: • Ability to work independently • Strong attention to detail • Strong interpersonal, time management and organizational skills • Good oral/written communication and analytical skills • Must be able to work in a high-performance environment that changes often • Experience in navigating multiple systems using dual monitors • Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92 Codes, and standard of billing guidelines required. • FACETS experience (highly preferred) • Medicaid knowledge (required) • Keyboard skills of at least 35 WPM + 10-key • Proficient in Microsoft Office - Excel, Word, and Outlook • Healthcare claims payer processing experience (required) • Ability to work at a high pace while maintaining quality and productivity targets Working Environment Requirement: • Ability to work remotely in a secure environment (required) • Must have a high-speed internet connection (required) • Must have high-speed internet modem with the ability to connect laptop to a wired connection port (Required) • Must have a workspace and location free from distractions and safety of healthcare data (required) Salary and Other Compensation: Applications will be accepted until October 10th, 2025. The annual salary for this position is between $17.00 - $20.00 depending on the experience and other qualifications of the successful candidate. This position is also eligible for Cognizant's discretionary annual incentive program and stock awards, based on performance and subject to the terms of Cognizant's applicable plans. Benefits: Cognizant offers the following benefits for this position, subject to applicable eligibility requirements: • 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 salary, 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. The Cognizant community: We are a high caliber team who appreciate and support one another. Our people uphold an energetic, collaborative and inclusive workplace where everyone can thrive. • Cognizant is a global community with more than 300,000 associates around the world. • We don't just dream of a better way - we make it happen. • We take care of our people, clients, company, communities and climate by doing what's right. • We foster an innovative environment where you can build the career path that's right for you. About us: Cognizant is one of the world's leading professional services companies, transforming clients' business, operating, and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build, and run more innovative and efficient businesses. Headquartered in the U.S., Cognizant (a member of the NASDAQ-100 and one of Forbes World's Best Employers 2024) is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com Cognizant is an equal opportunity employer. Your application and candidacy will not be considered based on race, color, sex, religion, creed, sexual orientation, gender identity, national origin, disability, genetic information, pregnancy, veteran status or any other characteristic protected by federal, state or local laws. Disclaimer: Compensation 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. Applicants may be required to attend interviews in person or by video conference. In addition, candidates may be required to present their current state or government issued ID during each interview. Apply tot his job