• Hybrid Claims Adjudicator

    Cognizant (Winston Salem, NC)


    Hybrid Claims Adjudicator- Winston Salem, NC

    Overview:

    We are seeking a Claims Adjudicator in Winston Salem, North Carolina with 1 to 2 years of experience in Claims Adjudication. _Training will be 4-6 weeks In-Office, then this role will be 100% remote_ . The ideal candidate will have a good understanding in Medicare, Medicaid Claims, Appeals and Grievances, and Commercial Claims. With a focus on accuracy and timeliness you will utilize your expertise in MS Excel to analyze data and support the claims process. This hybrid role offers a balanced work environment allowing you to contribute effectively while maintaining a healthy work-life balance.

    Responsibilities:

    + Analyze and process claims with precision to ensure timely resolution and customer satisfaction.

    + Utilize MS Excel to manage and interpret data enhancing the efficiency of claims processing.

    + Collaborate with team members to identify trends and patterns in claims data for continuous improvement.

    + Communicate effectively with stakeholders to provide updates and resolve any issues related to claims.

    + Ensure compliance with company policies and industry regulations throughout the claims process.

    + Support the appeals and grievances process by providing accurate data and insights.

    + Contribute to the development of process improvements to streamline claims operations.

    + Maintain accurate records and documentation for all claims activities.

    + Assist in training new team members on claims processes and best practices.

    + Participate in regular team meetings to discuss progress and share insights.

    + Provide exceptional customer service by addressing inquiries and concerns promptly.

    + Monitor and report on key performance indicators related to claims processing.

    + Adapt to changing priorities and work effectively in a fast-paced environment.

    Qualifications:

    + High School Diploma **Required**

    + Should have at least 2 years of experience in the medical field, either through work or volunteer roles.

    + FACETS experience is an added advantage

    + Experience in claims hospital and professional claims adjudication is mandatory.

    + Experience in other clinical services search program management and health records is an added advantage.

    + A strong understanding of Claims, Appeals and Medical Benefits

    + Proficiency in computer skills including typing speed and accuracy

    + Good written and verbal communication skills

    + Ability to maintain a high level of integrity and confidentiality of medical information

    Cog2025

    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.