Claims analyst Jobs in Philadelphia, PA

At Cognizant, we're not just about technology; we're about pioneering solutions that create meaningful transformations. We're looking for innovative minds, problem-solvers who are passionate about making a difference in the fast-paced world of technology. If you're ready to challenge the status quo and drive excellence, we want you on our team.

Purpose :

This position is responsible for working with business partners within one business function to align technology solutions with business strategies; eliciting, documenting, and refining business requirements; serving as a liaison between the business community and the IT organization in order to provide technical solutions to meet user needs. Duties include : Work as a liaison among partners to elicit, analyze, communicate, and validate requirements for changes to business processes, policies, and information systems; Assist in the analysis of business problems and opportunities in the context of the requirements and recommend solutions that enable the organization to achieve its goals; Define and document business, user, and functional requirements using appropriate documentation techniques to describe statements of the goals, objectives, or needs of a particular stakeholder or group of stakeholders (on projects of low complexity); Work with business partners within one business function to align technology solutions with business strategies; Translate high-level business requirements into functional specifications for the Configuration and IT organization and lead changes to such specifications (with senior business analyst oversight through peer reviews); Develop an informed knowledge of the business unit being supported, as well as an understanding of the IT organization's systems and capabilities in order to participate in project activities and research requests on an ongoing basis; Assist in obtaining consensus by facilitating communication between business unit's) and IT from initial requirements to final implementation; From a project perspective, owns the entire DM and ensure it is implemented based on customer needs; Requirements and project artifacts are completed in accordance with SDM methodologies; Maintain complete confidentiality of company business; Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as the need arises or requested; Communicate and interact optimally and expertly with co-workers, management, customers, etc.; Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies; Maintain complete confidentiality of company business; Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested; and other duties as assigned. Maintain and particpate in all Mass Health forums to understand, translate and implement Mass Health guidelines to remain compliant with all regulations and requirements.

Essential Functions :

• 3+years Medicare / Medicaid regulatory healthcare experience
• Knowledge of claim adjudication processes and Facets platform experience preferred
• Experience transforming complex technical requirements into an easily understood summary
• Analytical skills including critical thinking and problem solving
• Clear and concise verbal and written communication skills
• PC proficiency to include Microsoft Word, Excel, and Outlook
• Organizational skills including attention to detail and multi-tasking skills
• Experience working both independently and in a team environment
• Extensive knowledge of Massachusettes Medicaid Mass Health laws required
• Experience with Mass Health governing policies and proedures and procedural knowledge of the CMR and Bulletin releases and forums
• Behavioral Health requirement understanding in both Medicare, dual and Mass Medicaid required

Location : Fully Remote

Salary and Other Compensation :

The hourly rate for this position is $34,611-$67,000, dependent on experience and other qualifications of the successful candidate.

This position is also eligible for Cognizant's discretionary annual incentive program, based on performance and subject to the terms of Cognizant's applicable plans.

Benefits : Cognizant offers the following benefits for this position, subject to applicable eligibility requirements :

Disclaimer : The salary, other compensation, and benefits information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.

Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

If you have a disability that requires a reasonable accommodation to search for a job opening or submit an application, please email [email protected] with your request and contact information. Applications are accepted on an ongoing basis.

Applications will be accepted through February 21st, 2025

The Cognizant community :

We are a high caliber team who appreciate and support one another. Our people uphold an energetic, collaborative and inclusive workplace where everyone can thrive.

About us :

Cognizant (Nasdaq-100 : CTSH) is one of the world's leading professional services companies, helping organizations modernize technology, reimagine processes and transform experiences, so they stay ahead in a fast-changing world.

Our commitment to diversity and inclusion :

Cognizant is an equal opportunity employer that embraces diversity, champions equity and values inclusion. We are dedicated to nurturing a community where everyone feels heard, accepted and welcome. Your application and candidacy will not be considered based on race, color, sex, religion, creed, sexual orientation, gender identity, national origin, disability, genetic information, pregnancy, veteran status or any other protected characteristic as outlined by federal, state or local laws.

Disclaimer :

Compensation information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.

Applicants may be required to attend interviews in person or by video conference. In addition, candidates may be required to present their current state or government issued ID during each interview.

The Cognizant community :

We are a high caliber team who appreciate and support one another. Our people uphold an energetic, collaborative and inclusive workplace where everyone can thrive.

About us :

Cognizant 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 and one of Forbes World's Best Employers 2024) is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com

Our commitment to diversity and inclusion :

Cognizant is an equal opportunity employer that embraces diversity, champions equity and values inclusion. We are dedicated to nurturing a community where everyone feels heard, accepted and welcome. Your application and candidacy will not be considered based on race, color, sex, religion, creed, sexual orientation, gender identity, national origin, disability, genetic information, pregnancy, veteran status or any other protected characteristic as outlined by federal, state or local laws.

Disclaimer :

Compensation information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.

Applicants may be required to attend interviews in person or by video conference. In addition, candidates may be required to present their current state or government issued ID during each interview.