Facets Benefits

2 weeks ago

Hyderabad, Telangana, India Cognizant Full time
At Cognizant, together with your colleagues from all around the world, you will collaborate on creating solutions for the world's leading companies and help them become more flexible, more innovative, and successful. Primary Skill: Facets Benefits / Pricing Configuration and Claim Validation

We are seeking an experienced Facets Benefits / Pricing and Claim Validation Analyst or Quality Analyst to join Cognizant Healthcare team.. The ideal candidate will bring deep expertise in configuring the Facets Benefits / Pricing module , with a focus on provider contracting, claims adjudication, and benefit / pricing plan setup. This role requires a strong understanding of healthcare domain and hands-on experience with benefit/pricing and network configuration within the Facets platform.

Engineering / bachelor's degree or equivalent qualification with minimum 3-6 years of relevant hands-on experience in Facets Benefits or Pricing Configurations and Claim Validation.

Must have strong knowledge in API testing and EDI 278 transactions.

Hands on experience in SQL database testing is required.

Set up and manage 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 or escalations

Ensure compliance with Medicare, Medicaid , and commercial payer guidelines

Participate in testing and validation of benefits or pricing setups to ensure accurate claim outcomes

Document configuration changes and maintain audit-ready records

Work with cross-functional teams including IT, business analysts, and QA to implement and troubleshoot system changes

CTSH) is one of the world's leading professional services companies, transforming clients' business, operating and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build and run more innovative and efficient businesses. Headquartered in the U.Learn how Cognizant helps clients lead with digital at or follow us @Cognizant.

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