Job Summary

Cognizant is hiring a PE – Claims HC (Claims Adjudication Specialist) to join its dynamic healthcare operations team. In this role, you will be responsible for processing and evaluating healthcare insurance claims while ensuring accuracy, compliance, and timely resolution. The position involves working in a fast-paced environment and requires strong analytical, communication, and claims adjudication skills.

Key Responsibilities

• Process healthcare claims efficiently to ensure timely adjudication and resolution.
• Evaluate claims for accuracy and compliance with company policies.
• Maintain detailed records of processed claims for future reference.
• Collaborate with team members to resolve discrepancies and improve workflows.
• Communicate effectively with stakeholders to clarify claim details.
• Ensure compliance with regulatory requirements and company standards.
• Identify potential issues and suggest improvements in claims processing systems.
• Support the team in achieving departmental targets and operational goals.
• Stay updated with healthcare industry trends and claims adjudication best practices.

Basic Qualifications

• Any Graduate from a recognized university.
• 0 – 1 year of experience in healthcare claims or BPO operations.
• Strong understanding of claims adjudication and healthcare processes.
• Excellent written and spoken English communication skills.
• Ability to work in night shifts from the office.
• Strong analytical and problem-solving abilities.

Preferred Qualifications

• Certified Professional in Healthcare Quality (CPHQ) or equivalent certification.
• Experience in US Healthcare or payer domain.
• Knowledge of medical billing, denial management, and RCM processes.
• Experience in claims processing, payment posting, and healthcare operations.

Key Skills

• Claims Adjudication
• Healthcare Claims Processing
• US Healthcare / Payer Domain
• Medical Billing
• Denial Management
• Payment Posting
• Customer Service & Communication
• Compliance & Operations Management