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Senior Process Executive-Data

2 months ago

Bangalore, India Cognizant Full time


Job Summary

We are seeking a dedicated Senior Process Executive - HC with 1 to 3 years of experience in Claims Adjudication. The ideal candidate will have a strong background in Claims and Payer domains. This role involves ensuring accurate and timely processing of claims contributing to the efficiency and effectiveness of our healthcare operations.


Responsibilities

Ensure accurate and timely adjudication of healthcare claims.Review and analyze claims data to identify discrepancies and resolve issues.Collaborate with team members to streamline claims processing workflows.Maintain up-to-date knowledge of payer policies and regulations.Provide support and guidance to junior team members on claims adjudication processes.Utilize claims adjudication software to process and track claims.Communicate effectively with internal and external stakeholders to resolve claims-related inquiries.Monitor and report on claims processing metrics to ensure compliance with performance standards.Participate in continuous improvement initiatives to enhance claims processing efficiency.Conduct regular audits of claims to ensure accuracy and compliance with payer requirements.Assist in the development and implementation of training programs for new hires.Ensure all claims are processed in accordance with company policies and industry standards.Contribute to the overall success of the healthcare operations team by meeting or exceeding performance targets.

Qualifications

Possess strong analytical skills to review and adjudicate claims accurately.Demonstrate proficiency in using claims adjudication software.Exhibit excellent communication skills to interact with stakeholders effectively.Have a thorough understanding of payer policies and healthcare regulations.Show ability to work collaboratively in a team environment.Display attention to detail to ensure accuracy in claims processing.Bring experience in the Claims and Payer domains to the role.Be adaptable and open to continuous learning and improvement.Have a proactive approach to identifying and resolving issues.Demonstrate commitment to maintaining high standards of quality and compliance.Possess the ability to train and mentor junior team members.

Certifications Required

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