Sme-claims Hc

2 weeks ago

Bengaluru Karnataka, India Cognizant Full time

**Job Summary**

Join our team as a Subject Matter Expert in Claims HC where you will leverage your expertise in Facets Claims and Claims Adjudication to optimize our claims processing systems. With a focus on Dental and Commercial Claims you will play a pivotal role in enhancing operational efficiency and ensuring compliance with industry standards. This office-based role offers the opportunity to work in a dynamic environment contributing to impactful projects that benefit both the company and society.

**Responsibilities**
- Lead the analysis and optimization of claims processing workflows to enhance efficiency and accuracy.
- Oversee the implementation of Facets Claims and Claims Adjudication systems to ensure seamless integration and functionality.
- Provide expert guidance on Dental and Commercial Claims processes to ensure compliance with industry standards.
- Collaborate with cross-functional teams to identify and resolve system issues improving overall operational performance.
- Develop and maintain documentation for claims processing procedures to support training and knowledge sharing.
- Monitor and evaluate system performance recommending improvements to enhance service delivery.
- Conduct regular audits of claims processes to ensure adherence to regulatory requirements and company policies.
- Facilitate training sessions for team members to enhance their understanding of claims systems and processes.
- Analyze data trends to identify opportunities for process improvements and cost savings.
- Support the development of new claims processing initiatives to drive innovation and efficiency.
- Communicate effectively with stakeholders to provide updates on project progress and system enhancements.
- Ensure that all claims processing activities align with the companys strategic goals and objectives.
- Contribute to the development of best practices for claims management to support continuous improvement. Qualifications
- Demonstrate proficiency in Facets Claims and Claims Adjudication with a strong understanding of system functionalities.
- Possess in-depth knowledge of Dental and Commercial Claims processes and industry standards.
- Exhibit excellent analytical skills to identify and resolve complex system issues.
- Show strong communication skills in English both written and verbal to effectively collaborate with team members.
- Display a proactive approach to problem-solving and process improvement.
- Have a minimum of 5 years of experience in claims processing with a focus on Dental and Commercial Claims.
- Be able to work independently and manage multiple tasks in a fast-paced environment.

**Certifications Required**

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

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