Provider Appeals Specialist

About the Position

We are seeking a Provider Appeals Specialist to review, research, process, and resolve provider appeals related to claims payment and reimbursement disputes. This role serves as a liaison between healthcare providers, payer organizations, and internal departments to ensure appeals are handled accurately, timely, and in compliance with regulatory requirements, company policies, state laws, and contractual agreements. This is a remote role for candidates that live in the United States.

Responsibilities

• Review and investigate provider appeals related to denied, adjusted, or underpaid claims.
• Analyze claim histories, medical records, authorization documentation, contracts, and payment information to determine appeal outcomes.
• Interpret provider agreements, reimbursement methodologies, benefit plans, and healthcare regulations.
• Research root causes of claim disputes and identify appropriate corrective actions.
• Ensure HIPAA compliance when preparing and distributing appeal status notifications, determinations, and resolution correspondence.
• Ensure appeals are processed within established service-level agreements (SLAs) and regulatory timelines.
• Collaborate with cross-functional teams to research, evaluate, and resolve complex appeal cases.
• Maintain accurate documentation of all appeal activities in applicable systems and databases.
• Escalate high-risk or complex appeals to leadership when appropriate.
• Monitor trends in appeals activity and recommend process improvements to reduce recurring issues.
• Support quality audits, regulatory reviews, and compliance initiatives.
• Participate in training, client, and internal meetings.

Requirements

• A High School diploma or equivalent is required; Associate's or Bachelor's degree preferred.
• 2+ years of experience in healthcare claims, provider services, appeals, billing, or related healthcare operations.
• Knowledge of medical terminology, healthcare claims processing, reimbursement methodologies, and payer guidelines.
• Understanding of CMS regulations, commercial insurance guidelines, and healthcare compliance standards.
• Experience working with healthcare claims management systems and Microsoft Office applications.
• Strong analytical, problem-solving, and investigative skills.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities and meet strict deadlines.

Nice to Have

• Experience in managed care, health insurance, Medicare, Medicaid, or provider relations.
• Familiarity with ICD-10, CPT, HCPCS, and revenue coding.
• Knowledge of provider contracts and reimbursement structures.
• Healthcare-related certification or continuing education.

We Offer

• Competitive salary: $18 - $19 per hour.
• Discretionary annual incentive program based on performance.
• 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.

About the Company

Cognizant (Nasdaq: CTSH) is an AI Builder and technology services provider, bridging the gap between AI investment and enterprise value by building full-stack AI solutions for our clients. Our deep industry, process, and engineering expertise enables us to build an organization’s unique context into technology systems that amplify human potential, drive tangible outcomes, and keep global enterprises ahead in a fast-changing world. See how at cognizant.ai or follow us on Twitter.

Working Conditions

• Remote work.
• Frequent interaction daily working directly with the client.
• Work may involve handling confidential patient and provider information in accordance with HIPAA regulations.
• Ability to meet productivity, quality, and turnaround time requirements.

Application Deadline: Applications will be accepted until August 21st, 2026.

Equal Opportunity Employer: Cognizant is an equal opportunity employer. Your application and candidacy will not be considered based on race, color, sex, religion, creed, sexual orientation, gender identity, national origin, disability, genetic information, pregnancy, veteran status, or any other characteristic protected by federal, state, or local laws.

Reasonable Accommodation: If you have a disability that requires reasonable accommodation to search for a job opening or submit an application, please email [email protected] with your request and contact information.