Provider Appeals & Grievances Specialist (remote)
Cognizant, Nashville, Tennessee, United States, 37247
Overview
Provider Appeals & Grievances Specialist (remote)
is a remote position open to any qualified applicant that lives in the United States. This is a work-from-home position with day hours, no travel required, and attendance during training (approximately 6 weeks) is mandatory. Responsibilities
Research and resolution of Medicaid provider appeals that involve member benefits, eligibility, provider contracts, billing and coding, Utilization Management, and state Medicaid policies. Maintain strong technical skills in MS Excel and navigate Microsoft programs in a fast-paced, production-driven environment. Ensure timely and accurate processing with a sense of urgency and responsiveness to email and MS Teams. Qualifications
1-2 years of Appeals and Grievances experience. 1 year of medical claims processing experience (must be with a healthcare plan, not on behalf of a provider or provider’s office). 2 years of medical health insurance experience (must be with a managed healthcare plan, not on behalf of a provider or provider’s office). 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, and compliance TAT. Self-resolved troubleshooting ability for various IT issues. Knowledge of QNXT, PEGA, and SharePoint. Ability to create professional written communication including spelling and grammar. Salary and Other Compensation
The hourly rate for this position is between $19.00 — 20.00 per hour, depending on experience and other qualifications of the successful candidate. Applications will be accepted until February 9, 2026. This position is 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. Note:
Cognizant will only consider applicants for this position who are legally authorized to work in the United States without requiring company sponsorship now or at any time in the future. Equal Opportunity Employer statement: 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.
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Provider Appeals & Grievances Specialist (remote)
is a remote position open to any qualified applicant that lives in the United States. This is a work-from-home position with day hours, no travel required, and attendance during training (approximately 6 weeks) is mandatory. Responsibilities
Research and resolution of Medicaid provider appeals that involve member benefits, eligibility, provider contracts, billing and coding, Utilization Management, and state Medicaid policies. Maintain strong technical skills in MS Excel and navigate Microsoft programs in a fast-paced, production-driven environment. Ensure timely and accurate processing with a sense of urgency and responsiveness to email and MS Teams. Qualifications
1-2 years of Appeals and Grievances experience. 1 year of medical claims processing experience (must be with a healthcare plan, not on behalf of a provider or provider’s office). 2 years of medical health insurance experience (must be with a managed healthcare plan, not on behalf of a provider or provider’s office). 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, and compliance TAT. Self-resolved troubleshooting ability for various IT issues. Knowledge of QNXT, PEGA, and SharePoint. Ability to create professional written communication including spelling and grammar. Salary and Other Compensation
The hourly rate for this position is between $19.00 — 20.00 per hour, depending on experience and other qualifications of the successful candidate. Applications will be accepted until February 9, 2026. This position is 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. Note:
Cognizant will only consider applicants for this position who are legally authorized to work in the United States without requiring company sponsorship now or at any time in the future. Equal Opportunity Employer statement: 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.
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