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Coordination of Benefits Representative

3 months ago

PR United States Optum Full time
Job Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The COB Representative is responsible for resolving escalated provider and member issues.  The successful COB Representative will perform root cause analysis, determine primacy, and update all systems to ensure that claims are processed correctly.  

Primary Responsibilities:

  • Verify other insurance coverage primarily through payer portals and clearinghouse portals, but also occasionally leverage automated phone lines, databases, or phone outreach to commercial payers
  • Data entry of other insurance coverage findings into internal applications
  • Work directly with other departments to enhance and refine assigned inventory to maximize value
  • Knowledge and application of Medicare and NAIC coordination guidelines to properly coordinate members
  • Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
  • Use pertinent data and facts to identify and solve a range of problems within area of expertise
  • Serves as a resource to others
  • Data entry into client submission systems
  • Other duties as assigned

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • 2+ years working in a production environment 
  • 1+ years of experience working in the health care industry (claims healthcare)
  • 1+ years of experience analyzing and solving customer problems
  • Intermediate level of Microsoft Excel
  • Demonstrated exemplary verbal and written communication skills in English
  • Willing or ability to work 40 hours weekly from Monday to Friday during our regular business hours from 7am to 7pm (Overtime as business needs dictate)

Preferred Qualifications:

  • Experience in an inbound/outbound
  • Coordination of Benefits experience
  • Experience working in the health care industry
  • Experience using platforms such as UNET, Pulse, NICE, Facets, Diamond, etc.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.