Provider Appeals & Grievances Specialist (remote)
Cognizant, Topeka, Kansas, United States, 66652
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, navigation skills for Microsoft programs in a 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 day hours, 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.
Basic qualifications
2 years of Appeals and Grievance experience
1 year of medical claims processing experience (Must be with a healthcare plan, not on behalf of provider or provider’s office)
Medicaid & Medicare insurance customer service or claims processing experience
2 years of medical health insurance experience (Must be with a managed healthcare plan, not on behalf of 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, 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 February 27, 2026.
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
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.
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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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, navigation skills for Microsoft programs in a 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 day hours, 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.
Basic qualifications
2 years of Appeals and Grievance experience
1 year of medical claims processing experience (Must be with a healthcare plan, not on behalf of provider or provider’s office)
Medicaid & Medicare insurance customer service or claims processing experience
2 years of medical health insurance experience (Must be with a managed healthcare plan, not on behalf of 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, 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 February 27, 2026.
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
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.
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.
#J-18808-Ljbffr