Claims Processor (with Facets) - Healthcare Remote

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 though our various wellbeing programs. Location: Remote (Work-from-Home) Schedule: Monday to Friday 8am - 4:30pm ET Experience: A minimum of 2 years of claim processing is required. Travel: None required About the role: As Claims Adjudication Specialist, you will be responsible for timely and accurate adjudication of professional and hospital claims utilizing payer specific policies and procedures. Provide support to claims and client for issues related to claims adjudication and adjustments. You will be a valued member of the Cognizant team and work collaboratively with stakeholders and other teams. In this role, you will:

• Be Responsible for reviewing the data in the claim processing system and comparing with corresponding UB or HCFA paper or EDI information.
• Responsible for reviewing medical records when necessary to determine if service rendered was medically appropriate and criteria have been met.
• Responsible for reviewing claim and line-item edits and warning messages for determination of whether to pay claim/line item(s).
• Ensuring all designated tasks are handled within the appropriate timeframe in order to meet internal and external SLAs.
• Assigning special projects or other duties as determined by management.

What you need to have to be considered:

• A minimum of 2 years claim processing is required.
• Knowledge of physician practice and hospital coding, and medical terminology, CPT, HCPCS, ICD-10
• Experience making payments with UB/institutional (CMS-1450) and/or professional (CMS 1500) claims
• Knowledge of Medicare/ Medicaid payment and coverage guidelines and regulations.
• 1 year of Facets experience.
• Experience in the analysis and processing of claims for payments, utilization review/quality assurance procedures.
• Must be able to work with minimal supervision.
• Good skills at problem resolution specifically related to healthcare claim adjudication.
• Possess ability to work at a computer for extended periods.
• Can work closely with other departments

Required Education and Experience · High School degree or GED or equivalent experience. 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. Salary and Other Compensation: Applications will be accepted until September 27th, 2025 The hourly rate for this position is between $15.25 - $17.75 per hour depending on experience and other qualifications of the successful candidate. 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. 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. Apply tot his job Apply To this Job