
Innovative Solutions Specialist
5 days ago
Cognizant seeks a skilled professional to collaborate on creating innovative solutions for leading companies.
Job DescriptionWe are looking for an experienced Benefit Configuration and Claim Validation Specialist to join our team. The ideal candidate will bring deep expertise in configuring benefit and pricing modules, focusing on provider contracting, claims adjudication, and plan setup.
This role requires a strong understanding of the healthcare domain and hands-on experience with configuration within the Facets platform. You will work closely with cross-functional teams to implement and troubleshoot system changes.
Required Skills and Qualifications- Deep expertise in configuring benefit and pricing modules
- Hands-on experience with API testing and EDI 278 transactions
- Strong knowledge of SQL database testing
- Experience with NetworX Pricer, Benefit Plans, and related configuration components
- Collaborate with Provider Contracting teams to translate business rules into system configuration
- Analyze and support Claims Adjudication processes related to benefits or pricing discrepancies
- Ensure compliance with Medicare, Medicaid, and commercial payer guidelines
- Participate in testing and validation of benefit or pricing setups
- Document configuration changes and maintain audit-ready records
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