Appeals Specialist (Healthcare) | Non-Voice | WFH | Pioneer - Taguig City

Embrace a global career with Cognizant - a leading organization catering to diverse industries worldwide. Our practice areas and supportive functions offer a vast array of opportunities for your talents. With a team of over 270,000 skilled associates, we are committed to Solving client issues and empowering them in the digital era. And that's not all - we have great news! We have expanded HMO coverage. Now is the time to give back to your loved ones with healthcare coverage. Plus, as part of our dedication to your growth, the Cognizant Learn Academy offers free training! Step into the future with us and become a part of Cognizant's success story!

Qualifications:

Job Responsibilities:

• Research, coordinate and resolve issues related to claims processing, eligibility, contracts, call history, benefits quotes, appeal decisions and decisions to reduce, modify or deny services to members. May determine proper solutions to issues raised by legal entities, members, and state and federal regulatory agencies.
• Document inquiries and formulate solutions to problems and issues.
• Review databases and files used to maintain accuracy, inputting corrections as necessary. Recognize and identify trends and presents findings to management.
• Approve/deny contractual disputes within limits of position authority.
• Collaborate and communicate verbally and in writing via phone, email, letter, etc. with external and internal sources regarding a variety of complaint and appeal issues which may include claims eligibility, contract issues, and/or the preparation and organization of member appeals.
• Accurately and timely maintenance of system and case file records for use in reporting appropriate department data.
• Represent the appeals area in meetings requiring team expertise and participation.
• Identify and communicate necessary contract revisions/clarifications based on defects identified. Interpret member benefit booklet contract language and/or provider contract language and apply it to the appeal issue.
• Meet or exceed departmental goals of production, accuracy, and timeliness.
• Work collaboratively with internal and external (including vendors) parties to thoroughly research and respond to all cases.
• As needed, assist with reviewing, entering, and appropriately responding to new inquiries and requests. Review and research incoming mail and faxes to determine the correct recipient and triage expedited appeals requests.
• Serve as back up to other team members as needed.
• Other duties as assigned.

Qualifications:

The typical incumbent will have a Degree in College and one (1) year of claims processing and/or customer service experience. Preferred incumbents will have experience in complaints or appeals, knowledge of the platforms, and/or an understanding of BlueCard Programs.

At a minimum, the incumbent must possess education and experience equivalent to College Degree and one (1) additional year of relevant experience.

Knowledge, Skills and Abilities:

• Proven research and analytical skills.
• Communicates verbally and in writing with external and internal sources regarding claims eligibility and contract issues.
• Proficiency with basic mathematical concepts.
• Strong verbal and written communication skills.
• Excellent customer relations skills, as well as the ability to communicate, and remain objective throughout difficult communications.
• Ability to work independently and as a member of a team on concurrent projects with across levels of employees.

Benefits:

Besides above industry-standard salary and clear career growth, you will also have HMO coverage* from day 1 of your job at Cognizant. The following are included in this benefit:

• Competitive medical coverage for the employee and family (parents, spouse, or domestic partner) **
• Medicine reimbursement for outpatients
• Maternity assistance
• Educational Assistance
• Life, accidental death and dismemberment, and total permanent disability insurance
• Laboratory, diagnostic and therapeutic procedures
• Annual Physical Exam (APE)
• Dental

How to Apply?

• Kindly complete all the questions, steps, and assessments online. Once done, you will receive an email invitation for virtual job fair.