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Spe – Claims Hc | Healthcare Claims Adjudication Specialist

Cognizant
Cognizant
2+ years
Not Disclosed
Bangalore, India
1 May 11, 2026
Job Description
Job Type: Full Time Education: B.Sc/M.Sc/M.Pharma/B.Pharma/Life Sciences Skills: mRS and EQ-5D-5L., Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs

SPE – Claims HC | Healthcare Claims Adjudication Specialist

Company: Cognizant
Job ID: 00068443681
Location: Bangalore, India
Work Model: Work from Office
Shift: Night Shift
Department: Technology & Engineering


About the Role

Cognizant is hiring for the position of SPE – Claims HC for its healthcare operations team in Bangalore. This role is ideal for professionals with expertise in Healthcare Claims Adjudication, Payer Operations, Claims Processing, Healthcare Compliance, and Medical Claims Analysis.

The selected candidate will be responsible for handling healthcare claims with accuracy and compliance while contributing to efficient payer operations and process improvement initiatives.

This opportunity is suitable for candidates experienced in healthcare claims workflows and healthcare operations environments.


Key Responsibilities

Healthcare Claims Adjudication

  • Process healthcare claims adjudication activities with high accuracy
  • Ensure compliance with organizational policies and healthcare industry regulations
  • Analyze claims data to identify discrepancies and resolve claim-related issues
  • Handle complex claims adjudication cases and provide accurate resolutions
  • Maintain confidentiality and security of sensitive healthcare claims information

Payer Operations & Process Management

  • Support payer operations by ensuring timely and accurate claims processing
  • Monitor claims adjudication metrics and suggest process improvements
  • Participate in audits and quality reviews to maintain operational accuracy
  • Develop and maintain documentation related to claims processing activities
  • Stay updated with healthcare payer guidelines and regulatory standards

Collaboration & Operational Excellence

  • Collaborate with internal teams to streamline claims workflows
  • Communicate effectively with stakeholders regarding claim status and issue resolution
  • Support implementation of new tools and technologies for claims operations
  • Provide guidance and best practice support to team members when required
  • Contribute to operational efficiency and continuous process improvement initiatives

Eligibility Criteria

Required Experience

Candidates should have experience in:

  • Healthcare Claims Adjudication
  • Payer Operations
  • Claims Processing
  • Healthcare Operations
  • Medical Claims Analysis

Suitable For

  • Experienced Healthcare Claims Professionals
  • Candidates with payer operations expertise
  • Professionals comfortable working in night shifts and office-based environments

Required Technical Skills

  • Strong understanding of healthcare claims adjudication processes
  • Knowledge of healthcare regulations and payer guidelines
  • Claims data analysis and discrepancy resolution
  • Familiarity with claims processing tools and healthcare systems
  • Strong analytical and problem-solving skills
  • Attention to detail and compliance management

Required Certifications

Candidates with the following certifications will be preferred:

  • Certified Professional Coder (CPC)
  • Certified Healthcare Claims Professional (CHCP)

Preferred Soft Skills

  • Strong verbal and written communication skills
  • Ability to work collaboratively in a team environment
  • Adaptability to night shift operations
  • Proactive learning attitude
  • Strong organizational and reporting abilities