Cognizant Job - 31293879 | CareerArc
  Search for More Jobs
Get alerts for jobs like this Get jobs like this tweeted to you
Company: Cognizant
Location: Phoenix, AZ
Career Level: Entry Level
Industries: Technology, Software, IT, Electronics

Description

Healthcare Claims Examiner PURPOSE:

Processing basic payments and/or claim denials for group health which includes medical, dental, vision, FSA, HSA, HRA and disability benefits; demonstrating the highest levels of customer service, technical skills and professionalism to ensure mutually rewarding and continued provider relationships.

ESSENTIAL FUNCTIONS:
  • 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 consistently met.
  • 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.
  • Approving, pending, or denying payment according to the accepted coverage guidelines.
  • Identifying and referring all claims with potential third party liability (i.e.,. subrogation, COB, MVA, stop loss claims, and potential stop loss files).
  • 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.
  • Examining and entering complex claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met.
  • Processing complex 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.
  • Troubleshooting all claims with potential third party liability, i.e. subrogation, COB, or MVA and stop loss claims and potential stop loss files.
  • Approving, pending, or denying payment according to the accepted coverage guidelines.
  • Assisting in training of new groups and new staff as needed; assisting the management team in problem resolution, planning and overseeing workflows; testing and preparing documentation and updating current documentation, as well as providing suggestions and recommendations to improve workflows and departmental efficiencies

EXPERIENCE: Qualifications:

  • High School diploma or GED required
  • 2-3 years Claims processing or directly related work experience.
  • Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92 Codes, and standard of billing guidelines required.
  • Must have FACETS exp
  • Must have Medicare knowledge
  • QicLink experience or certification preferred.
  • Audit experience preferred.
  • Proficient in Excel

Employee Status : Full Time Employee

Shift : Day Job

Travel : No

Job Posting : Dec 24 2019

About Cognizant

Cognizant (Nasdaq-100: CTSH) is one of the world's leading professional services companies, transforming clients' business, operating and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build and run more innovative and efficient businesses. Headquartered in the U.S., Cognizant is ranked 193 on the Fortune 500 and is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com or follow us @Cognizant.

Cognizant is recognized as a Military Friendly Employer and is a coalition member of the Veteran Jobs Mission. Our Cognizant Veterans Network assists Veterans in building and growing a career at Cognizant that allows them to leverage the leadership, loyalty, integrity, and commitment to excellence instilled in them through participation in military service.


 Apply on company website