Senior Consulting Manager, Healthcare Claims SME

About Cognizant Consulting Cognizant Consulting is more than Cognizantu2019s consulting practiceu2014weu2019re a global community of 5,000+ experts dedicated to helping clients reimagine their business. Blending deep industry and technology advisory capabilities, we deliver innovative solutions to Fortune 500 clients. And now, weu2019re looking for our next colleague to help shape the future of healthcare. Could it be you? About the role As a Senior Consulting Manager u2013 Healthcare Claims Analytics SME , you will make an impact by enabling healthcare payers to improve claims accuracy, reduce fraud, waste and abuse (FWA), and enhance payment integrity through advanced rule validation and analytics. You will be a valued member of Cognizantu2019s Healthcare Consulting team and will work collaboratively with clients, data engineering teams, and internal stakeholders to translate complex claims operations knowledge into scalable analytics solutions. In this role, you will: + Lead rule validation and optimization efforts across healthcare claims use cases, including coding intensity, E/M upcoding, frequency limits, and medical necessity rules + Define and refine disposition logic for claims reviews (e.g., SIU vs. Coding Review vs. Clinical Review) to improve operational efficiency and accuracy + Perform false positive analysis and root-cause reviews to improve rule precision and overall claim scoring performance + Support UAT testing for claims analytics solutions to ensure scoring accuracy and alignment with business intent + Document fraud, waste, and abuse patterns and partner with data and engineering teams to support feature engineering and rule enhancements Work model We strive to provide flexibility wherever possible. Based on this roleu2019s business requirements, this is a remote position open to qualified applicants in the United States . Regardless of your working arrangement, we are here to support a healthy work-life balance through our various wellbeing programs. The working arrangements for this role are accurate as of the date of posting and may change based on project or client requirements. We will always be transparent about role expectations. What you must have to be considered + 7+ years of experience in healthcare claims operations, payment integrity, or SIU functions + Strong hands-on experience with claims adjudication platforms such as Facets, QNXT, or HealthRules + Deep expertise in healthcare coding, including CPT, ICDu201110, HCPCS , with strong knowledge of E/M coding and modifiers + Demonstrated experience identifying and analyzing fraud, waste, and abuse patterns (e.g., upcoding, unbundling, HCC stacking) + Ability to translate business and operational requirements into clear technical inputs, including reviewing YAML-based rules and SQL queries (coding not required) These will help you succeed + Experience working with CMS National and Local Coverage Determinations (NCDs/LCDs) + Familiarity with provider profiling, peer benchmarking, and feature engineering concepts used in claims analytics + Strong communication skills with the ability to bridge clinical, operational, and technical teams + Experience supporting analytics product development or payer transformation initiatives Weu2019re excited to meet people who share our mission and can make an impact in a variety of ways. Donu2019t hesitate to applyu2014even if you meet only the minimum requirements. Your transferable experience and unique perspective could be exactly what this role needs. Compensation $134,500-$158,500 This position is eligible for Cognizantu2019s discretionary annual incentive program, based on performance and subject to the terms of Cognizantu2019s applicable plans Benefits + Medical, dental, vision and life insurance + 401(k) plan and contributions + Employee stock purchase plan + Employee assistance program + 10 paid holidays plus PTO + Paid parental leave and fertility assistance + Learning and development certifications and programsCognizant 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.

Created: 2026-03-27