About Us
Cognet HRO is a leading Business Process Outsourcing Services Company providing full range of HR and F&A; services to US based clients ,With over 17 years of rich experience in Payroll Tax, Benefits S & HR Administration, Finance & Accounting , Sales Support. CogNet has been serving the PEO, ASO, HRO and HR Technology spaces since our inception. We help organizations extend their capabilities through simplified implementation, productivity performance measured to the minute, easy collaboration, and transparent pricing built around real time utilization. Our extensive expertise, data library, and workflow development tools accelerates the client implementation process .We have developed a deep expertise of process and technology in our Services , which allows us to rapidly deliver value to our clients. Cognet has been delivering outsourced solutions to the clients around the Globe.
Job Description
US Healthcare Claims Adjudication – Senior Process Associate
Job Title
Senior Process Associate
Experience Required
4 – 6 Years
Timing
6:30 pm - 3:30 am
Job Summary
We are looking for an experienced US Healthcare Claims Adjudication Specialist with strong knowledge in end-to-end claims processing and payer guidelines. The candidate will be responsible for adjudicating medical claims accurately while ensuring compliance with CMS, HIPAA, and client-specific policies.
Key Responsibilities
Perform end-to-end US healthcare claims adjudication.
Verify member eligibility and benefits based on Date of Service (DOS).
Apply CPT, ICD-10, HCPCS, and payer adjudication rules accurately.
Process authorization, corrected, and duplicate claims.
Handle COB (Coordination of Advantages) and multi-insurance claims processing.
Review and manage denials, appeals, and claim reprocessing activities.
Calculate deductibles, copay, coinsurance, and out-of-pocket responsibilities accurately.
Identify non-covered services, exclusions, accident claims, and policy limitations.
Ensure c
📌 Senior Process Associate (India)
🏢 CogNet
📍 India