![L.A. Care Health Plan](https://media.trabajo.org/img/noimg.jpg)
Coordination of Benefits Validation Specialist Ii
1 month ago
Coordination of Benefits Validation Specialist II
**Job Category**:Administrative, HR, Business Professionals**Department**:Claims Integrity**Location**:Los Angeles, CA, US, 90017**Position Type**:Full Time**Requisition ID**:11187**Salary Range**: $50,216.00 (Min.) - $62,770.00 (Mid.) - $75,324.00 (Max.)- Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Job Summary
The Coordination of Benefits (COB) Validation Specialist ensures the accurate coordination of healthcare benefits for individuals covered under multiple insurance plans. The role involves validating coordination of benefits data, identifying discrepancies, and resolving issues to optimize benefit utilization and minimize costs. The COB Validation Specialist collaborates closely with various stakeholders, including insurance carriers, healthcare providers, and clients to ensure seamless coordination of benefits processing. The COB Validation Specialist conducts outbound calls to members and health plan carriers to validate coordination of benefits information. The Specialist proactively identifies, documents, investigates, and resolves COB issues in a timely and appropriate manner.
- Duties
Stakeholder Communication - Facilitate timely outreach and serve as a liaison between insurance carriers, healthcare providers, clients, and internal teams to facilitate effective communication and resolution of coordination of benefits issues. Provide guidance and support regarding coordination of benefits rules, coverage options, and claim submission processes. Conduct outbound calls to members and health plan carriers covered under multiple insurance plans to validate coordination of benefits information. (50%)
Data Validation - Review and validate coordination of benefits data, including insurance policies, coverage details, and claims information. Identify discrepancies and inconsistencies in coordination of benefits data through meticulous analysis and verification. (15%)
Discrepancy Resolution - Investigate and resolve discrepancies in coordination of benefits data, including overlapping coverage, duplicate claims, and payment responsibility conflicts. Collaborate with insurance carriers, healthcare providers, and clients to address discrepancies and ensure accurate billing and reimbursement. (15%)
Quality Assurance - Conduct quality assurance checks to ensure compliance with coordination of benefits regulations, policies, and procedures. Review documentation and reports for accuracy and completeness, making necessary corrections or adjustments as needed. (10%)
Perform other duties as assigned. (10%)
- Duties Continued
Education Required
Associate's Degree
Education Preferred
Bachelor's Degree
Experience
**Required**:
1 year of experience in healthcare insurance coordination, claims processing, or data validation.
Experience in Customer Service.
**Preferred**:
3 years of office experience in Managed Health Care.
- Skills
**Required**:
Solid understanding of standard claims processing, COB guidelines and data analysis.
Must have knowledge of HMO, PPO, EPO, POS, Government Funded, Medicare and Medicaid plans.
Ability to effectively prioritize and meet deadlines while managing multiple competing tasks.
Must have strong analytical skills.
Ability to work effectively with diverse team members and key internal and external stakeholders.
Excellent communication and interpersonal skills for effective collaboration with stakeholders at all levels.
Detail-oriented with a focus on accuracy and thorough documentation.
Ability to work independently and prioritize tasks in a fast-paced environment.
Proficient with Windows, Microsoft Office programs, and Outlook.
**Preferred**:
Must be familiar with coordinating benefits between health plan payers.
Knowledge of healthcare insurance regulations and coordination of benefits guidelines.
- Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Light
Additional Information
- **L.A. Care offers a wide range of benefits including**
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
**Nearest Major Market**:Los Angeles
**Job Segment**:Claims, Compensation, Medicaid, Medicare, HR, Insurance, Human Resources, Healthcare
We have other current jobs related to this field that you can find below
-
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $50,216.00 (Min.) - $62,770.00 (Mid.) - $75,324.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in...
-
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $50, Min.) - $62, Mid.) - $75, Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure...
-
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $50, Min.) - $62, Mid.) - $75, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $50,216.00 (Min.) - $62,770.00 (Mid.) - $75,324.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
-
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $50,216.00 (Min.) - $62,770.00 (Mid.) - $75,324.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
-
Environmental Health Specialist I/II/Senior
1 week ago
Los Angeles, United States County of Lake Full timeUnder general direction, assists with and learns to conduct sanitary inspections and investigations in environmental health conditions to enforce federal, state, county, and local environmental health, safety, and hazardous materials laws, ordinances, regulations, rules, and standards, obtaining compliance or corrective action, and educating the public...
-
Housing Specialist Ii
2 months ago
Los Angeles, United States Volunteers of America Los Angeles Full timeAbout Us: **_VOALA_** **_Helping Our Most Vulnerable Change Their Life Stories_** **PAY RATE**:$23.90-$25.16 PER HOUR **JOB SUMMARY AND PURPOSE** The Housing Specialist II is responsible for identifying suitable housing options for program participants and their families, and assisting the participants to achieve sustainable and healthy independent...
-
Sr. Validation Specialist, IT
2 months ago
Los Angeles, United States BioPhase Solutions Full timeJob DescriptionJob DescriptionBioPhase Solutions specializes in recruiting top talented professionals for Southern California's Scientific community. We are currently looking for a Sr. Validation Specialist, IT to work for a leading Greater Los Angeles area biopharmaceutical company.Salary: $110-130k depending on experienceSummary:The Sr. Validation...
-
Accounting Specialist I/II
1 week ago
Los Angeles, United States City of Bakersfield Full timeTHE POSITION: Under supervision, coordinates and performs duties related to preparing, processing, maintaining, and checking financial, statistical, or fiscal records for citywide finance programs; and performs related work as required. Accounting Specialist I: Graduation from high school or GED program; AND One (1) year experience in performing...
-
Housing Specialist II
4 weeks ago
Los Angeles, United States Volunteers of America Los Angeles Full timeJob DescriptionJob DescriptionAbout Us:VOALAHelping Our Most Vulnerable Change Their Life StoriesVolunteers of America is a non-profit human services organization committed to serving people in need, strengthening families, and building communities. VOALA provides a variety of social services to Los Angeles area communities such as Head Start programs,...
-
Care Management Coordinator II
2 months ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $50, Min.) - $62, Mid.) - $75, Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure...
-
Care Management Coordinator II
7 days ago
Los Angeles, United States L.A. Care Health Plan Full timePress Tab to Move to Skip to Content Link Select how often (in days) to receive an alert: Select how often (in days) to receive an alert: Salary Range: $50,216.00 (Min.) - $62,770.00 (Mid.) - $75,324.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to...
-
Learning and Development Specialist II
1 month ago
Los Angeles, United States Volunteers of America Los Angeles Full timeJob DescriptionJob DescriptionAbout Us:VOALAHelping Our Most Vulnerable Change Their Life StoriesVolunteers of America is a non-profit human services organization committed to serving people in need, strengthening families, and building communities. VOALA provides a variety of social services to Los Angeles area communities such as Head Start programs,...
-
Care Management Coordinator II
2 months ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $50,216.00 (Min.) - $62,770.00 (Mid.) - $75,324.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
-
Affiliate Relations Specialist
1 month ago
Los Angeles, United States NEA Member Benefits Full timePOSITION FUNCTION AND PURPOSE The Affiliate Relations Specialist (AR Specialist) is responsible for providing direction, visibility, program integration, and expanding market access and penetration for NEA MB programs in state and local affiliates within a defined territory. The AR Specialist connects with members face-to-face and through other direct...
-
Learning and Development Specialist II
2 months ago
Los Angeles, United States Voala Full timeHelping Our Most Vulnerable Change Their Life Stories Volunteers of America is a non-profit human services organization committed to serving people in need, strengthening families, and building communities. VOALA provides a variety of social services to Los Angeles area communities such as Head Start programs, Upward Bound college prep programs, veterans...
-
Claims Documentation Specialist II
1 month ago
Los Angeles, United States L.A. Care Health Plan Full timeClaims Documentation Specialist II Job Category: Claims Department: Claims Data and Support Services Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 10588 Salary Range: $77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of...
-
Enhanced Care Management Coordinator II
3 days ago
Los Angeles, United States L.A. Care Health Plan Full timePress Tab to Move to Skip to Content Link Select how often (in days) to receive an alert: Enhanced Care Management Coordinator II Job Category: Clinical Department: Care Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11207 Salary Range: $50,216.00 (Min.) - $62,770.00 (Mid.) - $75,324.00 (Max.) Established in...
-
Veteran Peer Support Specialist Ii
1 month ago
Los Angeles, United States Volunteers of America Los Angeles Full timeAbout Us: **_VOALA_** **_Helping Our Most Vulnerable Change Their Life Stories_** **PAY RATE**:$22.22 - $23.39 PER HOUR **JOB SUMMARY AND PURPOSE** As a staff member of the treatment team, the Peer Support Specialist II/Battle Buddy is an experienced and certified advocate who performs a wide range of tasks to assist peers in regaining independence within...
-
Claims Documentation Specialist II
2 weeks ago
Los Angeles, United States L.A. Care Health Plan Full timePress Tab to Move to Skip to Content Link Select how often (in days) to receive an alert: Claims Documentation Specialist II Job Category: Claims Department: Claims Data and Support Services Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 10588 Salary Range: $77,265.00 (Min.) - $100,445.00 (Mid.)...