Complex Claims Representative

About the Role As a Complex Claims Representative, you will play a vital role in supporting our clients by investigating, evaluating, and resolving complex claims involving auto insurance coverage, litigation, and workers' compensation. You will be part of Cognizant's dedicated claims team, handling inbound and outbound calls while collaborating with internal stakeholders to uphold quality and compliance standards in claims administration. In this role, you will: Identify and manage auto claims, litigation, workers' compensation claims, and health insurance verifications. Investigate specific reasons for underpayments, denials, and payment delays and take appropriate action. Track and trend claim denials and underpayments to identify opportunities for payer, process, or technology improvements. Maintain a thorough understanding of federal and state regulations, as well as payer-specific requirements. Partner with management to identify, trend, and address root causes of claims issues. Make recommendations for additions, revisions, or deletions to work queues and claim edits to improve efficiency. Identify patterns and elevate to management with sufficient detail to support root cause resolution. Document all actions and updates accurately in account records, including contact names, addresses, and pertinent information. Contribute to team success by assisting with other responsibilities as assigned. Work Schedule Monday through Friday - shifts start between 7:00 AM and 9:00 AM CST (9-hour shifts). This is a remote position open to qualified applicants across the United States. Candidates must be available to work CST/EST hours. We prioritize flexibility and support your wellbeing through a variety of programs designed to promote a healthy work-life balance. Please note: Working arrangements are accurate as of the posting date and may evolve based on project or client needs. If changes occur, we will communicate expectations clearly. What you need to have to be considered: High school diploma or GED equivalent Exceptional problem-solving and critical thinking skills; must meet quality and productivity standards Strong verbal and written communication skills These will help you stand out: Working knowledge of auto coverage, litigation, and workers' compensation claims Knowledge of state/federal billing guidelines, reimbursement methodologies, and payer policies Understanding of the RCM cycle, auto coverages, and Medicare, Medicaid, Managed Care, and Commercial payer processes Experience tracking and trending claim denials and underpayments Familiarity with payer-specific requirements and billing compliance Background in legal, litigation, or compliance-related claims handling Cognizant will only consider applicants for this position who are legally authorized to work in the United States without requiring company sponsorship now or at any time in the future. Hourly Rate and Other Compensation The hourly rate for this position is between $19.00 – $22.00 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. 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. Applications will be accepted until June 30, 2026. Benefits 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 Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law. #J-18808-Ljbffr Cognizant