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eCOB Specialist II
1 month ago
eCOB Specialist II Location: Hybrid, within 50 miles of an Elevance Health Pulse Point location. Hours: Monday - Friday, 8am - 4:30pm EST The eCOB Specialist II is responsible for researching and investigating other coverage for all of the company's groups and members 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. How you will 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/groups 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 adjudicate impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines. Minimum Requirements: Requires a HS diploma or equivalent and a minimum of 2 years of claims processing and customer service and 2 years COB experience that required using NAIC & CMS COB guidelines; or any combination of education and experience which would provide an equivalent experience. Preferred Skills, Capabilities, and Experiences: Knowledge of NAIC & CMS COB guidelines strongly preferred. Excellent oral and written communication skills, PC skills, database system, and related software (word processing, spreadsheets, etc.) strongly preferred. For candidates working in person or remotely in the below locations, the salary* range for this specific position is $19.20 to $34.55. Locations: California; Colorado; District of Columbia; Hawaii; Nevada; New York; Washington State. In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). #J-18808-Ljbffr
