eCOB Specialist III

3 weeks ago

Houston, United States Elevance Health Full time

Coordination of Benefits Specialist III

Schedule: 1-2 days per week in the office (Hybrid 1)

Location: This position will work on a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

The Coordination of Benefits Specialist III is responsible for researching and investigating other coverage for all of the company's groups and member on multiple platforms. Fully proficient in all key areas; performs multi complex functions and interprets complex rules, laws and contracts. Accountable for end-to-end functionality on every Coordination of Benefits(COB) function including reconciliation of claim, membership and accounting.

This is how will you make an impact:

  • Utilizes internal queries, internal resource tools, must initiate delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS and Medicaid and report to identify members who are or should be enrolled in other coverage.

  • Aides members in enrolling in Medicare when they are entitled. Determines primacy on each case using a complex set of Primacy Rules as mandated by State and Federal Laws, such as CMS Primacy and NAIC rules and comparing them against the member/group Benefits.

  • Updates all of the company's membership system components with investigation results for claim coordination.

  • Ensures correct forms are provided to assist members enrolling in Medicare.

  • Reviews claim history to identify claims requiring reconciliation, whether processed or pended, as well as recovered in error.

  • Associate must identify the correct formulas in order to adjudicates impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines.

  • Handles complex case research and resolution.

  • May assist with training of new associates.


Minimum Requirements:

  • Requires a HS diploma or equivalent and a minimum of 3 years of claims processing and customer service and 3 years COB experience that required using NAIC & CMS COB guidelines; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

  • Medicaid WGS experience strongly preferred

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