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Cognizant

Healthcare - Team Lead - Military veterans preferred

Cognizant - Phoenix, AZ



PURPOSE: The Claims Supervisor will oversee a claims processing team of approximately 15-20 full time and contractor staff processing medical claims. They are responsible for overseeing for ensuring production and quality on a daily basis. They will also assist Assisting with the process of claim adjudication, ensuring that eligibility (including COB), referral/authorizations, and payments are appropriate based on contracts, regulations, industry claim payment standards, and company policies and procedures. Assisting members and providers in the meeting of commercial and/or governmental medical claim and dental reimbursement, representing the company throughout the transaction.

ESSENTIAL FUNCTIONS:

Leading the claims processing team to meet or exceed performance standards and quality expectations.
Provide team critical feedback, coaching and coordinate re-training where developmental challenges have been identified.
Participate in CMS-facing or client-facing meetings and presentations as needed.
Communicate with multiple levels of leadership. Examining and entering complex claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met.
Processing claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit.
Maintaining external and internal customer relations by interacting with staff regarding claims issues.
Providing service as the key contact for clients and working as directed with the clients vendors. Researching and ensuring accurate and complete claim information, contacting insured or other involved parties for additional or missing information and updating information to claim file with regard to claims status, questions or claim payments.
Support departmental goals of maintaining process controls, including CMS guidance; as well as internal and external audits.
Identifying and referring all claims with potential third party liability, such as subrogation, COB, MVA, stop loss claims and potential stop loss files.
Approving, pending, or denying payment according to the accepted coverage guidelines.Assisting in training of new groups and new staff as needed; assisting the management team in problem resolution, planning and overseeing workflows; testing and preparing documentation and updating current documentation; as well as providing suggestions and recommendations to improve workflows and departmental efficiencies.

QUALIFICATIONS:
Education: High school diploma, GED Certificate or equivalent.
Experience: Minimum of five years' related experience. Experience with or Certification in QicLink preferred. Audit experience preferred.
Technical Competencies:
Knowledge of medical terminology including CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92 Codes, and standard of billing guidelines.
Behavioral Competencies:

Ability to establish meaningful team goals and objectives in order to drive team performance
Effective team player, reliable and flexible in adapting to change Well organized with the ability to effectively prioritize work
Ability to think outside-the-box in search of solutions
Ability to work effectively cross-functionally
Demonstrate ability to document and present concepts in a clear and concise manner
About CognizantCognizant is one of the world's leading professional services companies, transforming clients' business, operating and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build and run more innovative and efficient businesses. Headquartered in the U.S., Cognizant, a member of the NASDAQ-100, is ranked 205 on the Fortune 500 and is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com or follow us on Twitter:USJobsCognizant. Cognizant is recognized as a Military Friendly Employer and is a coalition member of the Veteran Jobs Mission. Our Cognizant Veterans Network assists Veterans in building and growing a career at Cognizant that allows them to leverage the leadership, loyalty, integrity, and commitment to excellence instilled in them through participation in military service.

3 days 23 hours ago

Cognizant

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Healthcare - Team Lead - Military veterans preferred Cognizant - Phoenix, AZ, United States

   

Location: Phoenix, AZ

Company Profile:
Cognizant combines a passion for client satisfaction, technology innovation, deep industry and business process expertise and a global, collaborative workforce that embodies the future of work. With over 50 delivery centers worldwide and approximately 260, 200 employees as of December 31, 2016, Cognizant is a member of the NASDAQ-100, the S&P 500, the Forbes Global 2000 and the Fortune 500 and is ranked among the top performing and fastest growing companies in the world.