Provider Appeals & Grievances Specialist (remote) at Cognizant - Thailand

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Full Time

Start Date

Immediate

Expiry Date

29 Jan, 26

Salary

18.0

Posted On

31 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Appeals And Grievance Experience, Medical Claims Processing, Medicaid Insurance, Customer Service, Billing And Coding, Member Appeals, Provider Appeals, Compliance, IT Troubleshooting, QNXT, PEGA, SharePoint, Production Urgency, Professional Communication

Industry

IT Services and IT Consulting

Description

Provider Appeals & Grievances Specialist (remote) This is a remote position open to any qualified applicant that lives in the United States. Summary: We are seeking a dedicated Provider Appeals & Grievance Specialist with 1 to 2 years of experience to join our team. The ideal candidate will have strong technical skills in MS Excel, knowledge/navigation skills for Microsoft programs in fast paced, production driven environment and dedication to attendance adherence. Absences will not be permitted during training-approximately 6 weeks. This is a work-from-home position with hours from Monday- Friday from 8 am - 4:30pm EST, and no travel is required. Candidate will also have the desire to further their abilities and knowledge of Medicaid medical insurance processes as they will be responsible for the research and resolution of Medicaid provider appeals that will involve research of member benefits, eligibility, provider contracts, billing and coding, Utilization Management and state Medicaid policies. Qualifications/Skills Needed: 2 years minimum Appeals and Grievance experience 2 years medical claims processing experience (Must be with a healthcare plan, not on behalf of provider or provider’s office) Medicaid insurance customer service or claims processing Medicaid/Medicare Insurance Customer Service with managed care plans or directly with CMS Billing and Coding-Medical Insurance Knowledge of Member/Provider Appeals and Grievances, processes, resolutions, compliance TAT Self-resolved troubleshooting ability for various IT issues Knowledge of QNXT Knowledge of PEGA Knowledge of SharePoint Sense of urgency with production and responsiveness to email and MS Teams Ability to create and fax written communication in a professional manner including spelling and grammar. Salary and Other Compensation: Applications will be accepted until November 5, 2025. The hourly rate for this position is between $17.00 – 18.00 per hour, depending 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: • Medical/Dental/Vision/Life Insurance • Paid holidays plus Paid Time Off • 401(k) plan and contributions • Long-term/Short-term Disability • Paid Parental Leave • Employee Stock Purchase Plan Disclaimer: The hourly rate, 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. Cog2025

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Responsibilities

The Provider Appeals & Grievance Specialist will be responsible for researching and resolving Medicaid provider appeals. This includes navigating member benefits, eligibility, provider contracts, billing and coding, Utilization Management, and state Medicaid policies.