Provider Appeals & Grievances Specialist; remote

Overview

Provider Appeals & Grievances Specialist (remote)

This is a remote position open to any qualified applicant that lives in the United States.

• Responsible for the research and resolution of Medicaid provider appeals involving member benefits, eligibility, provider contracts, billing and coding, Utilization Management and state Medicaid policies.
• Maintain strong technical skills (MS Excel) and navigation of Microsoft programs in a fast-paced, production-driven environment with a focus on attendance adherence. Absences will not be permitted during training (approximately 6 weeks).
• Work from home with day hours; no travel required.
• Respond to inquiries via email and MS Teams with a sense of urgency and professionalism in written communications.

• 1-2 years of Appeals and Grievance experience
• 1 year of medical claims processing experience (must be with a healthcare plan, not on behalf of provider or provider’s office)
• 2 years of medical health insurance experience (must be with a managed care plan, not on behalf of provider or provider’s office)
• Experience with Medicaid/Medicare Insurance Customer Service with managed care plans or directly with CMS
• Billing and Coding—Medical Insurance
• Knowledge of Member/Provider Appeals and Grievances processes, resolutions, and compliance turnaround times (TAT)
• Self-resolved troubleshooting ability for various IT issues
• Knowledge of QNXT, PEGA, and Share Point
• Sense of urgency with production and responsiveness to email and MS Teams
• Ability to create and fax written communications in a professional manner including spelling and grammar

• Applications will be accepted until February 9, 2026.
• The hourly rate for this position is between $19.00 – 20.00 per hour, depending on experience and other qualifications of the successful candidate.
• This position is 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

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 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.

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.