Public Consulting Group

Senior Claims Specialist

Job Locations US-NH-Portsmouth | US-MA-Boston
Posted Date 2 months ago(7/29/2021 4:49 PM)
Job ID
# of Openings
Regular Full-Time
Practice Area
Health Services


Public Consulting Group, Inc. (PCG) is a leading public sector  solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG has over 2,500 professionals in more than 60 offices worldwide. PCG’s Health practice offers in-depth programmatic knowledge and regulatory expertise to help state and municipal health agencies respond to regulatory change, improve access to health care, maximize program revenue, improve business processes, and achieve regulatory compliance. Using industry best practices, PCG’s Health team helps organizations deliver quality services with constrained resources to promote improved client outcomes. To learn more, visit


  • Efficiently navigate the Cognizant/Trizetto QicLink claims system
  • Process paper and electronically submitted claims
  • Conduct further research into coding and pricing as needed
  • Accurately and timely respond to all correspondence from clients and/or their members
  • Resolve pended claims and process adjustments
  • Complete assigned claims tasks timely and accurately
  • Maintain understanding of departmental service standards, guidelines, policies, and procedures
  • Look for ways to improve efficiencies and minimize processing and workflow issues. Share information with team and management
  • Ensure Service Level Agreements (SLAs) and Key Performance Indicators (KPIs) are consistently attained



  • Demonstrated ability to use the QicLink claims system (a Cognizant suite of claims administration tools)
  • Proper etiquette including customer service techniques, superior verbal and communications skills
  • Excellent claim processing accuracy and attention to detail
  • Ability to prioritize work and meet deadlines
  • Ability to work in a fast-paced environment, demonstrate excellent problem solving, critical thinking, and organizational skills
  • Ability to recognize and maintain the confidentiality of all materials in the work setting
  • Understanding of modern office methods and practices; efficient with computers
  • Ability to work independently

Education:    High School Diploma or GED required; Bachelor's Degree preferred


Experience:  5+ years in the health insurance/revenue cycle industry (required)

                       5+ years’ in-depth knowledge of Medicare, Medicaid and Medicare Advantage experience (preferred)

                       Previous experience with claims processing system (required)

                       Familiarity with Cognizant TriZetto healthcare products, specifically QicLink (required)






EEO Statement

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.


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