Job Summary

Serve as a subject matter expert in health care claims adjudication with a focus on payer and provider operations using advanced MS Excel skills to analyze claim data and resolve complex issues in a hybrid night shift role. Contribute to improving claims accuracy member satisfaction and cost efficiency while collaborating with cross functional teams to optimize end to end claims processes.

Responsibilities

• Analyze health care claim batches with meticulous attention to payer and provider rules to ensure accurate adjudication and timely resolution of claims while working primarily in a night shift hybrid mode
• Review complex claim scenarios and apply adjudication guidelines to identify discrepancies adjust payments and minimize financial leakage for the organization and its stakeholders
• Utilize advanced MS Excel functions such as lookups and pivot based analysis to interpret large data sets spot claim processing trends and propose corrective actions that improve operational performance




• Collaborate with payer and provider operations teams to clarify benefit designs coding interpretations and contract terms to support precise claim decisions and consistent application of policies
• Document detailed claim adjudication rationales and maintain clear audit ready records that support compliance with internal standards and external regulatory expectations
• Investigate claim related issues escalated by internal teams and external partners provide clear resolutions and communicate findings that strengthen trust and transparency in claims processing
• Monitor key performance indicators related to claims turnaround times payment accuracy and rework rates and contribute insights that guide continuous improvement initiatives across the claims lifecycle
• Support implementation of process enhancements by validating rule changes testing calculation logic using structured MS Excel models and sharing structured feedback that reduces defects in production
• Prov

📌 SME-Claims HC (Pune)
🏢 Cognizant
📍 Pune