Job Summary

This hybrid role is for a claims processing professional in health care with focus on HIPAA compliance and claims adjudication for provider and payer clients in a night shift schedule. The role involves accurate review of health care claims application of benefit rules and timely resolution of discrepancies to support high quality member and provider experiences.

Responsibilities

Review health care claims with close attention to detail to ensure accurate capture of member demographics benefit data and provider information while working in a hybrid night shift model
Apply claims adjudication rules to determine eligibility coverage limits and cost sharing so that claims outcomes align with payer policies and contractual agreements
Validate claims data for completeness and consistency and raise issues promptly so that incorrect information does not lead to payment errors or delays
Interpret benefit plans and provider contracts to calculate member and payer financial responsibility and document outcomes clearly in the system of record




Check claims against policy exclusions benefit maximums and coordination of benefits rules to minimize overpayments underpayments and rework
Use HIPAA compliant workflows when accessing and updating member and provider information so that privacy and security requirements are consistently met
Research claim discrepancies by referencing benefit documents historical claims and standard operating procedures to identify root causes and propose accurate resolutions
Collaborate with internal operations quality and configuration teams through virtual channels to clarify advantages rules and ensure consistent adjudication outcomes across cases
Respond to queries from provider and payer stakeholders by providing clear claim status updates and explanations that support trust and reduce repeat contacts
Track individual claim queues and turnaround time targets during night shift schedules to support timely completion of work and achieveme

📌 PE-Claims HC (Kochi)
🏢 Cognizant
📍 Kochi