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Senior Process Executive - HC

Cognizant

5 - 7 years

Bengaluru

Posted: 17/05/2025

Job Description



Job Summary

We are seeking a highly skilled Senior Process Executive - HC with 3 to 5 years of experience in Facets - Claims and Claims Adjudication. The ideal candidate will have expertise in Dental Claims and Commercial Claims. This role requires working in a hybrid model with night shifts. Proficiency in English is essential.


Responsibilities

  • Oversee the end-to-end claims adjudication process to ensure accuracy and compliance with company policies and regulations.
  • Provide expert analysis and resolution of complex claims issues particularly in the areas of Dental Claims and Commercial Claims.
  • Collaborate with cross-functional teams to streamline claims processing workflows and improve efficiency.
  • Utilize Facets
  • Claims software to manage and process claims accurately and efficiently.
  • Ensure all claims are processed within the stipulated timeframes and meet quality standards.
  • Conduct regular audits of claims to identify and rectify discrepancies.
  • Train and mentor junior team members on best practices in claims adjudication and the use of Facets
  • Claims software.
  • Develop and implement process improvements to enhance the overall claims processing system.
  • Communicate effectively with internal and external stakeholders to resolve claims-related queries and issues.
  • Maintain up-to-date knowledge of industry regulations and standards related to claims processing.
  • Generate and analyze reports on claims processing performance and provide insights for continuous improvement.
  • Participate in team meetings and contribute to the development of strategies for optimizing claims operations.
  • Ensure adherence to data privacy and confidentiality policies in all claims processing activities.

    • Qualifications

  • Possess a strong understanding of Facets
  • Claims software and its application in claims adjudication.
  • Have in-depth knowledge of Dental Claims and Commercial Claims processing.
  • Demonstrate excellent analytical and problem-solving skills in resolving complex claims issues.
  • Exhibit strong communication skills in English both written and verbal.
  • Show proficiency in training and mentoring junior team members.
  • Display the ability to work effectively in a hybrid work model with night shifts.

    • Certifications Required

    Certified Professional Coder (CPC) or equivalent certification in claims processing.

    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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