Job Summary

Responsibilities:
Coordinate complex member enrollment and billing activities across multiple payer and provider systems to ensure timely and accurate processing of all transactions in a night shift setting.

Ensure strict adherence to HIPAA regulations when handling enrollment data and billing records so that all protected health information remains secure and fully compliant.

Analyze advantages open enrollment files and eligibility feeds to validate member elections identify discrepancies and recommend corrective actions that prevent downstream billing issues.

Design and refine enrollment and billing workflows that reduce manual effort minimize defects and accelerate cycle time while maintaining high standards of quality and compliance.

Collaborate with payer and provider stakeholders to clarify benefits rules eligibility criteria and coverage configurations so that enrollment data aligns with contractual obligations.





Perform root cause analysis on recurring enrollment and billing defects and develop sustainable remediation plans that reduce rework and improve customer satisfaction.

Create and maintain detailed documentation for enrollment rules billing logic file formats and exception handling so that project teams and operations staff can execute processes consistently.

Coordinate with technology teams to translate business requirements for HIPAA compliant enrollment and billing solutions into clear functional specifications and acceptance criteria.

Validate inbound and outbound enrollment and billing files using test cases that reflect real world payer and provider scenarios to confirm system reliability and data integrity.

Monitor key performance indicators for enrollment accuracy billing timeliness and error rates and propose data driven improvements that align with organizational objectives.

Guide junior analysts by sharing domain insights on payer and provider operations explaining complex benefit structures and demonstrating best practi

📌 Tm-enrollment & Billing (Pune)
🏢 Cognizant
📍 Pune