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Senior Process Executive - HC

Cognizant

4 - 6 years

Bengaluru

Posted: 26/02/2025

Job Description



Job Summary

We are seeking a dedicated Senior Process Executive - HC with 1 to 4 years of experience in Claims Adjudication. The ideal candidate will have a strong understanding of the healthcare domain particularly in commercial claims claims and payer processes. This role requires working from the office during night shifts. Travel is not required.


Responsibilities

  • Process healthcare claims with a focus on accuracy and compliance with regulatory standards.
  • Ensure timely adjudication of claims to meet service level agreements and performance metrics.
  • Analyze and resolve complex claims issues to ensure proper payment and adjudication.
  • Collaborate with internal teams to streamline claims processing and improve efficiency.
  • Maintain up-to-date knowledge of healthcare regulations and payer policies.
  • Provide support and guidance to junior team members to enhance their skills and knowledge.
  • Utilize claims adjudication systems and tools to process and track claims.
  • Conduct regular audits of claims to identify and correct errors.
  • Communicate effectively with stakeholders to resolve claims-related inquiries and issues.
  • Prepare and present reports on claims processing performance and trends.
  • Participate in continuous improvement initiatives to enhance claims processing workflows.
  • Ensure compliance with company policies and procedures in all claims processing activities.
  • Maintain confidentiality and security of patient information in accordance with HIPAA regulations.

    • Qualifications

  • Possess a minimum of 1 year of experience in claims adjudication.
  • Demonstrate strong analytical and problem-solving skills.
  • Exhibit excellent communication and interpersonal skills.
  • Have a good understanding of commercial claims claims and payer processes.
  • Show proficiency in using claims adjudication systems and tools.
  • Be detail-oriented with a focus on accuracy and compliance.
  • Display the ability to work effectively in a night shift environment.
  • Have a proactive approach to identifying and resolving issues.
  • Be capable of working independently and as part of a team.
  • Show commitment to continuous learning and professional development.
  • Maintain a high level of integrity and ethical standards.
  • Demonstrate the ability to handle confidential information with discretion.
  • Possess strong organizational and time management skills.

    • Certifications Required

    Certified Professional Coder (CPC) or Certified Claims Professional (CCP) preferred.

    About Company

    Cognizant is a global leader in technology and consulting services, helping businesses transform their operations through digital solutions. Specializing in IT services, including software development, business process outsourcing, and consulting, Cognizant supports clients across industries such as healthcare, financial services, manufacturing, and retail. With a focus on innovation, Cognizant assists organizations in modernizing their technology, improving operational efficiency, and enhancing customer experiences. Headquartered in the U.S., it is consistently ranked among the most admired companies in the world and is a member of the NASDAQ-100.

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