SPE – Claims HC | Healthcare Claims Adjudication Specialist

SPE – Claims HC | Healthcare Claims Adjudication Specialist

Company: Cognizant
Job ID: 00068443971
Location: Coimbatore, India
Work Model: Work from Office
Department: Technology & Engineering
Shift: Night Shift

About the Role

Cognizant is hiring a SPE – Claims HC professional for its healthcare operations team in Coimbatore. This role is ideal for candidates with experience in Claims Adjudication, Healthcare Claims Processing, Payer Operations, and Claims Data Analysis.

The selected candidate will play a critical role in ensuring accurate, compliant, and efficient claims processing while contributing to operational excellence and process optimization within the healthcare domain.

This opportunity is best suited for professionals with 2 to 4 years of experience in Claims Adjudication and Healthcare Claims Operations.

Key Responsibilities

Claims Adjudication & Processing

  • Process healthcare claims accurately and efficiently
  • Ensure compliance with organizational standards and healthcare industry regulations
  • Analyze claims data to identify discrepancies and resolve issues promptly
  • Utilize claims adjudication expertise to improve claims accuracy and operational reliability
  • Maintain detailed documentation for audit and reporting purposes

Healthcare Operations & Workflow Optimization

  • Collaborate with internal teams for seamless claims processing and issue resolution
  • Monitor claims processing metrics and identify improvement opportunities
  • Implement corrective actions to enhance operational efficiency
  • Provide recommendations to improve claims workflows and reduce processing errors
  • Support strategic process optimization initiatives using claims domain expertise

Regulatory Compliance & Reporting

  • Ensure adherence to healthcare regulations and payer guidelines
  • Maintain compliance in all claims-related activities
  • Prepare reports and maintain accurate claims records
  • Stay updated with evolving healthcare industry trends and regulatory changes

Team Collaboration & Communication

  • Communicate effectively with stakeholders regarding claims status and issue resolution
  • Support training initiatives to improve team capabilities in claims adjudication
  • Contribute to collaborative team environments and organizational goals
  • Demonstrate strong written and verbal English communication skills

Eligibility Criteria

Required Experience

Candidates should have 2 to 4 years of experience in:

  • Claims Adjudication
  • Healthcare Claims Processing
  • Healthcare Operations
  • Claims Data Analysis
  • Payer Operations (preferred)

Suitable For

  • Experienced Healthcare Claims Professionals
  • Candidates with healthcare payer domain exposure
  • Professionals comfortable working in night shift office environments
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