Claims Process Executive; remote

Claims Processing - Hybrid

HYBRID
- Training in office
- Winston-Salem, NC- REQUIRED

Job Summary

Join our team as a Claims Processing Executive in the healthcare sector where you will utilize your expertise in MS Excel to efficiently manage and process commercial claims. This remote position offers the flexibility of working from home during day shifts allowing you to balance work and personal commitments effectively. Your contributions will directly impact the accuracy and efficiency of our claims processing enhancing customer satisfaction and operational excellence.

You will report to our office in Winston-Salem, NC for 6 weeks to complete our training regimen, this takes place Monday-Friday from 8-5pm EST.

• Claims Processing:
  Review, validate, and process healthcare claims submitted by providers in accordance with US insurance policies.
• Eligibility Verification:
  Confirm patient coverage, benefits, and pre-authorization requirements under Medicare, Medicaid, and private insurance plans.
• Adjudication:
  Approve, deny, or adjust claims based on payer guidelines and policy terms.
• Compliance:
  Maintain adherence to HIPAA regulations, CMS guidelines, and other US healthcare compliance standards.
• Documentation:
  Record claim activity, maintain audit trails, and prepare reports for management.

• High school diploma or equivalent REQUIRED
• Strong knowledge of US healthcare insurance systems (Medicare, Medicaid, commercial payers).
• 2–4 years of experience in US healthcare claims processing
• Familiarity with claims management software and EDI transactions.
• Excellent analytical, organizational, and communication skills.
• Ability to interpret insurance policies and payer guidelines.
• Detail-oriented with strong problem-solving abilities.

• Regulatory Knowledge – Deep understanding of US healthcare laws and payer requirements.
• Accuracy & Detail Orientation – Ensures claims are processed correctly and efficiently.
• Problem-Solving – Resolves claim disputes and denials effectively.

Applications will be accepted until January 20, 2026. The hourly rate for this position is between $16.00 – 17.00 per hour, depending on 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.