Cognizant Digital Operations Healthcare Senior Process Executive HC BHC114

title CWR summary Senior Process Executive - HC Graduate (exclusion: BE/ For Medical Management- Bachelor s degree in Nursing or any health science related field For NA- High School Processes:- Individuals in this role are responsible for meeting process deliverables in terms of targets including quality targets for complex transaction processes (knowledge intensive/ transaction value based) in clients/internal applications. They are expected to transcribe information from a variety of so 1to3yrs Skills Technical Skills- Domain Skills- to have skills Techincal Skills- Domain Skills- Call Center HC Healthcare Day & Responsibilities Senior Process Executive - HC Graduate (exclusion: BE/ For Medical Management- Bachelor s degree in Nursing or any health science related field For NA- High School Processes:- Individuals in this role are responsible for meeting process deliverables in terms of targets including quality targets for complex transaction processes (knowledge intensive/ transaction value based) in clients/internal applications. They are expected to transcribe information from a variety of sources into a standardized database system using various applications based on certain pre-defined rules. They also work on proactive identification of issues and assist the team in resolving the same. For Medical Management- Individuals in this role are responsible for performing medical review assessment (MRA) on utilization of health services (e.g. healthcare plans workers compensation products etc.) in an accurate efficient and timely manner while ensuring compliance with utilization management regulations and adherence to state and federal mandates. Responsible for evaluating the appropriateness of medical treatment and providing alternate recommendation to patients in case of inappropriate treatment. As required they may be responsible to review and refer cases for physician review and maintain the review data in the client/internal applications Engaged in quality reviews ensure effective and efficient quality assessment of MRAs using the approved quality assurance monitoring tool and updated template completion guidelines ForClaims- Individuals in this role are trained in complex specialties and their threshold would be around $5000. They also continue to work on all types of claims across all the LOBs Adjudication of claims across Commercial Medicare and Medicaid for Individual and Group businesses. They need to undergo training on Medical (Professional and Institutional claims across these LOBs. Responsible for monitoring and implementing contro Location Primary: USAZPHOC01-Phoenix - AZ USA CLT Alternate: Type 75CW00 Business Associate Requires Travel Y (s) Required N/A Project Code :