Claims Quality Auditor ? Remote

Cognizant is one of the world s leading professional services companies, we help our clients modernize technology, reinvent processes, and transform experiences, so they can stay ahead in our constantly evolving world. We are looking to expand our team. Do you thrive in a busy environment and able to multi-task successfully? If so, please apply today!

This position is responsible for handling... claims quality audits for internal and external clients.

Primary Responsibilities: Perform end to end audits on claims in both pre-pay/post-pay statuses. The claims are audited end to end to capture processing during the life cycle of the claim Will handle complex situations and acts with urgency to identify and resolve issues

Audit Check points are but limited to:
Claim data element: validation of claim date to system
Member: validation of correct member selection
Provider: validation of correct provider selection, service and remit addresses if required by client
Edits: validation of error codes, warning messages, edits for correct processing
Pricing: analyze claims for correct payment
Benefit application: member s cost share and limits are validated against the client s benefit grid
Compliance with Cognizant claims processing policies and procedures
Compliance with Medicare/Medicaid claims processing rules and edits provide through CES, Evicore, Cotiviti and Networx
Verification of correct selection of Explanation of Benefits reason codes, if applicable
Verification of client specific guidelines are followed which may supersede processing rules laid out by CMS
Interest Validation
Development / Learning
Other duties as assigned

Qualifications: High School diploma, GED equivalent 1+ years of experience in a processor role, processing Medicare/Medicaid claims or the knowledge, skills, and abilities to succeed in the role Working knowledge in healthcare or government programs Experience in researching and understanding complex information Ability to solve complex or ambiguous problems Ability to work independently in a fast-paced environment with multiple priorities Flexibility to adapt to frequently changing guidelines and processes Computer proficiency with Microsoft Office Excel, Word and Outlook Excellent verbal and written communication skills Organizational skills including attention to detail Ability to work scheduled shift hours including a variation in hours/days scheduled for remote staff Strong collaboration skills

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:

Applications will be accepted until October 11, 2024

The hourly rate for this position is between $14.50 - $19.00 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.

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

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