eCOB Coordination Specialist II

2 weeks ago

Columbus, Ohio, United States Elevance Health Full time

Elevance Health eCOB Coordination Specialist II

Location:
Hybrid, within 50 miles of an Elevance Health Pulse Point location.

Working Hours:
Monday - Friday, 8am - 4:30pm EST

The eCOB Coordination Specialist II plays a crucial role in examining and analyzing additional coverage options for all groups and members associated with the organization across various platforms.

Fully adept in all essential areas; executes multiple intricate functions and interprets complex regulations, statutes, and agreements. Responsible for comprehensive functionality on every Coordination of Benefits (COB) task, including the reconciliation of claims, membership, and financial records.

Key Responsibilities:

  • Utilizes internal queries and resource tools; initiates sensitive communications with other carriers, members, groups, providers, attorneys, CMS, and Medicaid to identify members who are or should be enrolled in alternative coverage.
  • Assists members in enrolling in Medicare when eligible.
  • Determines primacy for each case using a sophisticated set of Primacy Rules mandated by State and Federal Laws, such as CMS Primacy and NAIC regulations, comparing them against member/group benefits.
  • Updates all membership system components with investigation outcomes for claim coordination.
  • Ensures appropriate forms are provided to assist members in enrolling in Medicare.
  • Reviews claim history to identify claims needing reconciliation, whether processed or pending, as well as those recovered in error.
  • Identifies the correct methodologies to adjudicate affected claims, utilizing various COB Formulas for different product types, in accordance with State and Federal Guidelines.

Minimum Qualifications:

Requires a high school diploma or equivalent and a minimum of 2 years of claims processing and customer service experience, along with 2 years of COB experience that necessitated the use of NAIC & CMS COB guidelines; or any combination of education and experience that would provide equivalent expertise.

Preferred Skills and Experience:
Familiarity with NAIC & CMS COB guidelines is strongly preferred. Excellent verbal and written communication skills, proficiency in PC applications, database systems, and related software (word processing, spreadsheets, etc.) are highly desirable.

Compensation:
For candidates working in person or remotely in specified locations, the salary range for this position is $19.20 to $34.55.

In addition to salary, Elevance Health provides a comprehensive benefits package, incentive and recognition programs, equity stock purchase options, and 401k contributions (all benefits are subject to eligibility requirements).

The salary offered for this position is based on various legitimate, non-discriminatory factors set by the company.

Elevance Health is committed to ensuring equal pay opportunities for equal work, regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

This salary range reflects the company's good faith belief regarding the potential compensation for this role at the time of posting and may be adjusted in the future. Actual compensation may vary based on geographic location, work experience, education, and/or skill level.

No amount is considered wages or compensation until it is earned, vested, and determinable under the applicable policies and plans.

The amount and availability of any bonus, commission, benefits, or other forms of compensation and benefits that are allocable to a particular employee remain at the company's sole discretion unless and until paid and may be modified at the company's discretion, consistent with the law.

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