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SME-Claims HC @ Cognizant

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Cognizant  SME-Claims HC

Job Description



Job Summary

This role focuses on providing subject matter expertise in Claims Adjudication within the healthcare domain. The candidate will work from the office during night shifts ensuring accurate and efficient claims processing while adhering to industry standards and organizational goals.


Responsibilities

  • Analyze and adjudicate healthcare claims with precision ensuring compliance with organizational policies and regulatory guidelines.
  • Collaborate with cross-functional teams to resolve complex claims issues and provide insights for process improvement.
  • Monitor claims processing workflows to identify inefficiencies and recommend actionable solutions.
  • Provide subject matter expertise in claims adjudication offering guidance and support to team members and stakeholders.
  • Ensure timely and accurate processing of claims to meet service level agreements and organizational objectives.
  • Conduct detailed reviews of claims data to identify discrepancies and implement corrective measures.
  • Maintain up-to-date knowledge of healthcare regulations and payer policies to ensure compliance in claims adjudication processes.
  • Develop and document best practices for claims adjudication to enhance operational efficiency and accuracy.
  • Utilize advanced analytical tools to assess claims trends and provide actionable insights to management.
  • Communicate effectively with internal and external stakeholders to address claims-related inquiries and concerns.
  • Support training initiatives by sharing domain expertise in claims adjudication with new team members.
  • Ensure adherence to data security and confidentiality standards while handling sensitive claims information.
  • Contribute to the organizations mission by ensuring high-quality claims processing that positively impacts healthcare outcomes. Qualifications
  • Demonstrate strong expertise in claims adjudication processes including detailed knowledge of healthcare claims workflows.
  • Exhibit proficiency in healthcare domain skills particularly in claims management with a focus on accuracy and compliance.
  • Possess excellent communication skills in English both written and spoken to effectively interact with stakeholders.
  • Showcase familiarity with payer domain knowledge as a nice-to-have skill enhancing the ability to navigate payer-specific requirements.
  • Display a minimum of 4 years and a maximum of 6 years of relevant experience in claims adjudication and healthcare domain expertise.
  • Highlight the ability to work efficiently during night shifts in an office-based environment ensuring consistent productivity.
  • Demonstrate a proactive approach to identifying and resolving claims-related challenges contributing to organizational success.

    • Certifications Required

    Certified Professional Coder (CPC) Certified Healthcare Claims Professional (CHCP)

    Job Classification

    Industry: IT Services & Consulting
    Functional Area / Department: Customer Success, Service & Operations
    Role Category: Operations
    Role: Subject Matter Expert
    Employement Type: Full time

    Contact Details:

    Company: Cognizant
    Location(s): Coimbatore

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    Keyskills:   process providing workflow analytical us healthcare subject matter expertise claims adjudication process improvement healthcare claims processing compliance denial management claims english processing medical billing revenue cycle management communication skills

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    Cognizant

    Cognizant Softvision Cognizant Softvision creates impactful end-to-end digital products and solutions that result in relevant, memorable and rewarding interactions between brands and consumers. With a unique approach, we deliver sustainable innovation and business transformation for the world's...

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