Claims Processor

About the role: Location: Remote – US Schedule: M-F Eastern Hours Training: M-F 8am to 4:30pm ET. As a Claims Processor, you will make an impact by reviewing and adjudicating healthcare claims to ensure accurate payment or denial in accordance with established claim processing guidelines, regulatory requirements, and client business rules. You will be a valued member of the operations team, working collaboratively with internal stakeholders to maintain accuracy, productivity, and compliance standards. In this role, you will: Review and process healthcare claims for appropriateness of care and completeness of information in accordance with coverage guidelines and applicable state and federal regulations. Process claims across multiple benefit plans utilizing automated systems and manual review processes to determine accurate payment outcomes. Approve, pending, or deny claims based on accepted coverage guidelines and business requirements. Adhere to all team procedures, including HIPAA policies and procedures, while consistently meeting quality, turnaround time, and productivity goals. Identify and refer claims with potential third-party liability concerns, including subrogation, coordination of benefits (COB), motor vehicle accident (MVA), stop-loss claims, and related cases. Collaborate with internal teams to research claim issues, ensure accurate claim information, obtain additional documentation when needed, and provide claim status updates. Maintain accurate records and documentation within claims systems. Perform other duties and responsibilities as assigned. Be willing to work overtime as business needs require. We strive to provide flexibility wherever possible. Based on this role’s business requirements, this is a remote position open to qualified applicants in the United States. Regardless of your working arrangement, we are here to support a healthy work-life balance through our various wellbeing programs. The working arrangements for this role are accurate as of the date of posting. This may change based on the project you’re engaged in, as well as business and client requirements. Rest assured; we will always be clear about role expectations. What you need to have to be considered High School Diploma or GED required. Minimum 2-3 years of Medicaid and/or Commercial healthcare payer claims processing experience. Healthcare claims payer processing experience required. Medicaid claims processing knowledge required. Ability to work independently with strong attention to detail. Strong interpersonal, organizational, time management, and communication skills. Good analytical and problem-solving abilities. Ability to work in a fast-paced, high-performance environment with changing priorities. Experience navigating multiple systems using dual monitors. Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA, UB92 codes, and standard billing guidelines. Proficiency in Microsoft Office, including Excel, Word, and Outlook. These will help you stand out: Experience with FACETS claims processing system strongly preferred. Prior experience processing claims for multiple healthcare plans. Strong knowledge of healthcare regulations and payer guidelines. Demonstrated ability to maintain quality and productivity targets while managing high volumes of work. We're excited to meet people who share our mission and can make an impact in a variety of ways. Don't hesitate to apply, even if you only meet the minimum requirements listed. Think about your transferable experiences and unique skills that make you stand out as someone who can bring new and exciting things to this role. Working Environment Requirements: Ability to work remotely in a secure environment. High-speed internet connection required with the ability to connect a company-issued laptop through a wired connection or Wi-fi. Dedicated workspace is free from distractions and supports the privacy and security of healthcare information. Salary and Other Compensation Applications will be accepted until August 10th, 2026. The salary range for this position is $16.00 - $19.00 an hour depending on experience and other qualifications of the successful candidate. This position may also be eligible for Cognizant's discretionary annual incentive program and other compensation opportunities, based on performance and subject to the terms of Cognizant's applicable plans. Benefits Medical/Dental/Vision/Life Insurance Paid Holidays plus Paid Time Off 401(k) Plan and Company 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. 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. #J-18808-Ljbffr Cognizant