US Healthcare Claims SME

Cognizant

We are Looking for a strong US Healthcare Claims SME who can also play the Business Analyst role

Primary requirement: Deep Claims Adjudication expertise with 8–12+ years of relevant US Healthcare experience.
Understand and challenge complex Claims business requirements
Translate requirements into strong User Stories & Acceptance Criteria
Identify business-rule gaps, dependencies and exception scenarios
Guide Development & Testing teams throughout the sprint
Understand end-to-end adjudication including Benefits, Pricing, Provider, COB, Member liability, Denials/Pends, Adjustments and Reprocessing

Preferred: Agile/Scrum exposure, SQL knowledge and experience with Facets or a similar payer core administration platform.