Description

The Senior Process Executive will support Fraud, Waste & Abuse (FWA) activities through claims review, case analysis, and identification of potential irregularities within medical claims processing. The role requires strong claims knowledge, analytical thinking, attention to detail, and the ability to work independently in a fast-paced environment.

The successful candidate will undergo an accelerated training and capability-building programme of approximately 5.5 months before transitioning to full operational responsibilities."

Roles and Responsibilities:

• Review and analyse medical claims for potential Fraud, Waste & Abuse indicators

• Perform investigations on assigned FWA cases and document findings accurately.

• Conduct claim validation and identify irregular claim patterns or billing anomalies.

• Collaborate with internal stakeholders to obtain supporting information and clarify case details.

• Prepare case summaries, recommendations, and investigation outcomes in a timely manner.

• Ensure compliance with internal policies, operational procedures, and regulatory requirements.

• Meet productivity, quality, and turnaround time targets.

• Participate in continuous learning and FWA capability enhancement initiatives.

• Support ad-hoc projects and operational improvement activities as assigned.

Experience

1. Minimum -1-2 years of experience in medical claims processing, preferably in:
Outpatient (OP) Claims

Inpatient (IP) Claims

• Good understanding of healthcare claims adjudication and policy benefits.

• Strong analytical and problem-solving skills.

• High attention to detail and accuracy.

• Good written and verbal communication skills.

2. Senior Advisor - Minimum 3-5 years of experience in medical claims processing, preferably involving:

Outpatient (OP) Claims

Inpatient (IP) Claims

• Complex claims assessment or claims investigation

• Experience in quality review, coaching, or subject matter expertise is an added advantage.

• Demonstrated ability to work independently and manage complex cases.

• Strong stakeholder management and communication skills

• Self-disciplined and highly accountable.

• Demonstrates dedication and commitment to learning.

• Strong investigative mindset and critical thinking skills.

• Ability to handle confidential information with integrity.

• Adaptable and able to work under minimal supervision.

• Team player with a positive attitude and continuous improvement mindset.

Language:Must be Proficient in Cantonese (Written & Verbal)

About Cognizant:

Cognizant (Nasdaq: CTSH) engineers modern businesses. We help our clients modernize technology, reimagine processes and transform experiences so they can stay ahead in our fast-changing world. Together, we're improving everyday life. See how at www.cognizant.com or @cognizant.