Job Summary
Join our team as a Claims Specialist focusing on TL-Claims HC where you will utilize your expertise in Facets - Claims and Claims Adjudication. With 5 to 8 years of experience you will manage Dental and Commercial Claims ensuring accuracy and efficiency. This role requires working from the office during night shifts with no travel required. English proficiency is essential.
Responsibilities
- Manage and adjudicate claims using Facets
- Claims system ensuring accuracy and compliance with company standards.
- Analyze and process Dental and Commercial Claims identifying discrepancies and resolving issues promptly.
- Collaborate with team members to streamline claims processing and improve operational efficiency.
- Provide expert guidance on claims adjudication processes ensuring adherence to industry regulations.
- Monitor claims workflow and implement strategies to reduce processing time and enhance productivity.
- Conduct regular audits of claims to ensure compliance with internal and external policies.
- Develop and maintain documentation related to claims processes ensuring clarity and accessibility for team members.
- Communicate effectively with stakeholders to address claims-related inquiries and provide timely resolutions.
- Utilize advanced analytical skills to identify trends and propose solutions for claims management improvements.
- Train and mentor junior team members on claims processing techniques and best practices.
- Coordinate with cross-functional teams to ensure seamless integration of claims processes within broader business operations.
- Implement quality control measures to ensure high standards of claims processing are maintained.
- Report on claims processing metrics and provide insights to management for strategic decision-making.
Qualifications
- Possess strong expertise in Facets
- Claims and Claims Adjudication with proven experience in managing complex claims.
- Demonstrate proficiency in handling Dental Claims and Commercial Claims with a focus on accuracy and efficiency.
- Exhibit excellent communication skills in English both written and spoken to effectively interact with stakeholders.
- Show ability to work independently and collaboratively in a fast-paced office environment during night shifts.
- Display strong analytical skills to identify trends and propose actionable solutions for claims management.
- Have experience in training and mentoring team members to enhance their claims processing skills.
- Maintain a detail-oriented approach to ensure compliance with industry regulations and company policies.
Certifications Required
Certified Professional Coder (CPC) or Certified Claims Professional (CCP) relevant to claims processing.
关于高知特 (Cognizant)
高知特(Cognizant)（纳斯达克代码：CTSH）作为一家AI Builder和相关技术服务提供商，致力于通过打造全栈AI解决方案，帮助企业将人工智能投资转化为实际价值。公司凭借深厚的行业经验、流程优化和工程技术专长，将企业独特的业务场景融入科技系统，赋能组织释放人才潜能，推动切实成果，并帮助全球企业在瞬息万变的环境中保持领先。如需了解更多详情，敬请访问 cognizant.ai 或关注@cognizant。
补充雇佣信息
薪酬信息截至本职位发布之日为准。Cognizant 保留在适用法律允许的范围内随时修改该信息的权利。
申请人可能需要通过现场面试或视频会议的方式参加面试。此外，候选人在每次面试时可能需要出示其当前所在州或政府签发的有效身份证件。
Cognizant 是一家提供平等就业机会的雇主。在招聘过程中，您的申请和候选资格不会因种族、肤色、性别、宗教、信仰、性取向、性别认同、国籍、残疾、遗传信息、怀孕、退伍军人身份或任何其他受联邦、州或地方法律保护的特征而受到影响。
