Claims Examiner (remote)

Claims Examiner (remote)

This is a remote position open to any qualified applicant in the United States.

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:

1. 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 regularly met.

2. 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

3. Approving, pending, or denying payment according to the accepted coverage guidelines

4. Follows all team procedures, including HIPAA policies and procedures, and meets team quality, turnaround time and productivity performance standards and goals

5. Identifying and referring all claims with potential third-party liability (i.e., subrogation, COB, MVA, stop loss claims, and potential stop loss files)

6. 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

7. Other duties as assigned

8. Must be willing to work overtime when the business need requires.

Qualifications:

Education: High School diploma or GED required.

Experience: Minium of two to three years of Medicaid and or Commerical claims payer processing experience.

Technical Competencies:

1. Ability to work independently

2. Strong attention to detail

3. Strong interpersonal, time management and organizational skills

4. Good oral/written communication and analytical skills

5. Must be able to work in a high-performance environment that changes often

6. Experience in navigating multiple systems using dual monitors

7. Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92 Codes, and standard of billing guidelines required.

8. FACETS experience (Highly Preferred)

9. Medicaid knowledge (Required)

10. Keyboard skills of at least 35 WPM + 10-key

11. Proficient in Microsoft Office - Excel, Word, and Outlook

12. Healthcare claims payer processing experience (Required)

13. Ability to work in a high pace while maintaining quality and productivity targets

Working Environment:

1. Ability to work remotely in a secure environment (Required)

2. Must have high-speed internet connection (Required)

3. Must have highs-speed internet modem with ability to connect laptop to wired connection port (Required)

4. Must have a workspace and location free from distractions and safety of healthcare data (Required)

Salary and Other Compensation:

Applications will be accepted until May 31, 2025.

The hourly rate for this position is between $18.00 - 19.00 per hour, depending on experience and other
qualifications of the successful candidate.
This position is also eligible for Cognizant's discretionary annual incentive program, 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 hourly rate, 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.