Healthcare Claims Examiners

The Claims Examiner is responsible for reviewing and processing claim submissions in accordance with coverage guidelines, ensuring accurate decisions and compliance with regulatory requirements.

Location – Remote

Work Schedule:

Monday-Friday shifts from 6am-6pm EST.

Training

Schedule:

Monday-Friday 8am-4:30pm EST.

• Review and enter basic claims to ensure completeness, appropriateness of care, and compliance with coverage guidelines, including federal and state regulations.
• Process claims multiple plans using automated and manual benefits rules, determining correct payment based on system data and written documentation.
• Approve, pending, or deny claims according to accepted coverage guidelines.
• Follow team procedures, including HIPAA policies, and meet quality, turnaround, and productivity standards.
• Identify and refer claims involving potential third-party liability, including subrogation, COB, MVA, and stop-loss.
• Maintain effective internal customer service by researching claim issues, obtaining missing information, and updating claim files.
• Perform other duties as assigned and support overtime needs when required.

• 1+ years of Medicaid and commercial claims payer processing experience.
• High school diploma or equivalent.
• Strong organizational, time management, and communication skills.
• Excellent attention to detail.
• Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA, and UB92 codes, and standard of billing guidelines required.
• Strong Medicaid knowledge.
• Proficient in Microsoft Office (Excel, Word, and Outlook) and ability to navigate multiple systems using dual monitors.
• Ability to work at a high pace while maintaining quality and productivity target.

• Prior FACETS experience.

Cognizant will only consider applicants for this position who are legally authorized to work in the United States without requiring company sponsorship now or at any time in the future.

We are excited to meet people who share our mission and can make an impact in a variety of ways. Do not hesitate to apply, even if you only meet the minimum requirements listed. Think about your transferable experiences and unique skills that make you stand out as someone who can bring new and exciting things to this role.

Applications will be accepted until March 2, 2026.

The hourly rate for this position is between $18.00 – $19.00 per hour depending on the experience and other qualifications of the successful candidate.

This position is also eligible for Cognizant’s discretionary annual incentive program, based on performance and subject to the terms of Cognizant’s applicable plans.

• Medical/Dental/Vision/Life Insurance
• Paid holidays plus Paid Time Off
• 401(k) plan and contributions
• Long-term/Short-term Disability
• Paid Parental Leave
• Employee Stock Purchase Plan

Disclaimer:
The hourly rate, other compensation, and benefits information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.

Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.