The final salary or hourly wage, as applicable, paid to each candidate/applicant for this position is ultimately dependent on a variety of factors, including, but not limited to, the candidate’s/applicant’s qualifications, skills, and level of experience as well as the geographical location of the position.

Applicants must be legally authorized to work in the United States. Sponsorship not available.

Cognizant is seeking an Appeals and Grievances for remote opportunity.

Skills & Requirements

• 1-2 years of Appeals and Grievance, 1 Year of 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, knowledge/navigation skills for Microsoft programs in fast paced, production driven environment and dedication to attendance adherence. Training will be provided by client-Absences will not be permitted during training-about 6 weeks.
• 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.

Additional qualifications desired, are:
• Medicaid/Medicare Insurance Customer Service with managed care plans or directly with CMS
• Billing and Coding-Medical Insurance
• Strong written and verbal communication skills
• Self-resolved troubleshooting ability for various IT issues
• Knowledge of Member/Provider Appeals and Grievances, processes, resolutions, compliance TAT
• Sense of urgency with production and responsiveness to email and MS Teams
• Quality Driven
• Knowledge of QNXT
• Knowledge of PEGA
• Knowledge of SharePoint
• Ability to create and fax written communication in a professional manner including spelling and grammar.

Benefits/Other Compensation

This position is a contract/temporary role where Hays offers you the opportunity to enroll in full medical benefits, dental benefits, vision benefits, 401K and Life Insurance ($20,000 benefit).

Why Hays?

You will be working with a professional recruiter who has intimate knowledge of the industry and market trends. Your Hays recruiter will lead you through a thorough screening process in order to understand your skills, experience, needs, and drivers. You will also get support on resume writing, interview tips, and career planning, so when there’s a position you really want, you’re fully prepared to get it.

Nervous about an upcoming interview? Unsure how to write a new resume?

Visit the Hays Career Advice section to learn top tips to help you stand out from the crowd when job hunting.

Hays is committed to building a thriving culture of diversity that embraces people with different backgrounds, perspectives, and experiences. We believe that the more inclusive we are, the better we serve our candidates, clients, and employees. We are an equal employment opportunity employer, and we comply with all applicable laws prohibiting discrimination based on race, color, creed, sex (including pregnancy, sexual orientation, or gender identity), age, national origin or ancestry, physical or mental disability, veteran status, marital status, genetic information, HIV-positive status, as well as any other characteristic protected by federal, state, or local law. One of Hays’ guiding principles is ‘do the right thing’.
We also believe that actions speak louder than words.
In that regard, we train our staff on ensuring inclusivity throughout the entire recruitment process and counsel our clients on these principles. If you have any questions about Hays or any of our processes, please contact us.

In accordance with applicable federal, state, and local law protecting qualified individuals with known disabilities, Hays will attempt to reasonably accommodate those individuals unless doing so would create an undue hardship on the company. Any qualified applicant or consultant with a disability who requires an accommodation in order to perform the essential functions of the job should call or text 813.336.5570.

Drug testing may be required; please contact a recruiter for more information.

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