1. 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.
2. 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.
3. Approving, pending, or denying payment according to the accepted coverage guidelines.
4. Follows all team procedures, including HIPAA policies and procedures, and meets team quality, turnaround time and productivity performance standards and goals.
5. Identifying and referring all claims with potential third party liability (i.e.,. subrogation, COB, MVA, stop loss claims, and potential stop loss files).
6. 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.
7. Other duties as assigned
Employee Status : Full Time Employee
Shift : Day Job
Travel : No
Job Posting : May 31 2023
Applicants may be required to attend interviews in person or by video conference. In addition, candidates may be required to present their current state or government issued ID during each interview.
Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.
If you have a disability that requires a reasonable accommodation to search for a job opening or submit an application, please email CareersNA2@cognizant.com with your request and contact information.
