SPE Claims Processor
Qualification :
Cognizant will only consider applicants for this position whom are legally authorized to work in the United States without company sponsorship (H-1B, L-1B, L-1A, etc.).
• For Medical Management Bachelors degree in Nursing or any health science related field.
• For NA High School Equiv.
Responsibility :
Job description:
• Pay or deny claims according to the benefit summary
• Review membership eligibility for determination
• Assign correct provider for proper payment
• Follow all HIPA guidelines
• Review members out of pocket for correct cost share application
• Review COB information and apply it accordingly
• Review Error codes, warning messages and edits for correct processing
• Analyze claims for correct payment verification and adjust where needed
• Use of the Facets system to adjudicate claims
Preferred experience:
• Priority will be given to those with knowledge of the Facets systems and application
Required:
• High school diploma or GED
• Ability to work independently and with others in a fast pace production based environment
• A minimum of 4 years processing experience or degree/certification in Medicaid, Medicare or commercial claims
• Knowledge of COB and benefit summary
• Basic Excel skills
Good To Have Skills
• Claims
Domain Skills
SNo
Primary Skill
Proficiency Level *
Rqrd./Dsrd.
1
Claims
NA
Desired
* Proficiency Legends
Proficiency Level
Generic Reference
PL1
The associate has basic awareness and comprehension of the skill and is in the process of acquiring this skill through various channels.
PL2
The associate possesses working knowledge of the skill, and can actively and independently apply this skill in engagements and projects.
PL3
The associate has comprehensive, in-depth and specialized knowledge of the skill. She / he has extensively demonstrated successful application of the skill in engagements or projects.
PL4
The associate can function as a subject matter expert for this skill. The associate is capable of analyzing, evaluating and synthesizing solutions using the skill.