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Cognizant
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Process Specialist - HC

Process Specialist - HC

Cognizant

5 - 8 years

5 - 12 Lacs

Bengaluru

Posted:2 months ago| Platform:

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Skills Required

commercial fact analytical workflow time management customer service verbal communication claims adjudication problem solving monitoring claims processing continuous improvement compliance strong communication skills writing claims english communication skills

Work Mode

Work from Office

Job Type

Full Time

Job Description

Job Summary We are seeking a Process Specialist with 5 to 8 years of experience in Facets - Claims and Claims Adjudication. The ideal candidate will have expertise in Dental Claims and Commercial Claims. This role requires working from the office during day shifts. The candidate must be a native English speaker with strong reading writing and speaking skills. Responsibilities Oversee the claims adjudication process to ensure accuracy and compliance with company policies and regulations. Provide expertise in Facets Claims to streamline and optimize claims processing workflows. Analyze and resolve complex claims issues related to Dental Claims and Commercial Claims. Collaborate with cross-functional teams to improve claims processing efficiency and effectiveness. Develop and implement best practices for claims adjudication to enhance overall process quality. Monitor and report on key performance indicators to track the effectiveness of claims processing. Conduct regular audits of claims to identify and address any discrepancies or errors. Train and mentor junior team members on claims adjudication processes and best practices. Ensure all claims are processed within the established turnaround times and service level agreements. Participate in continuous improvement initiatives to enhance the claims processing function. Maintain up-to-date knowledge of industry trends and regulatory changes impacting claims adjudication. Provide exceptional customer service by addressing and resolving claims-related inquiries and issues. Contribute to the development of policies and procedures to support the claims adjudication process. Qualifications Possess strong technical skills in Facets Claims and Claims Adjudication. Have in-depth knowledge and experience in Dental Claims and Commercial Claims. Demonstrate excellent analytical and problem-solving abilities. Exhibit strong communication skills both written and verbal in English. Show proficiency in training and mentoring team members. Display a commitment to continuous improvement and process optimization. Maintain a high level of attention to detail and accuracy in all tasks. Have the ability to work effectively in a fast-paced dynamic environment. Demonstrate strong organizational and time management skills. Possess a customer-focused mindset with a dedication to providing exceptional service. Show proficiency in using relevant software and tools for claims processing. Exhibit a strong understanding of industry regulations and compliance requirements. Demonstrate the ability to work collaboratively with cross-functional teams. Certifications Required Certified Professional Coder (CPC) or equivalent certification in claims processing.

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Process Specialist - HC