eCOB Coordination Specialist

2 weeks ago

Cincinnati, Ohio, United States Elevance Health Full time

Job Overview

The eCOB Coordination Specialist plays a crucial role in investigating and verifying alternative coverage for members and groups across various platforms. This position requires comprehensive knowledge in all essential areas, handling multiple complex tasks while interpreting intricate regulations, laws, and contracts. The specialist is accountable for the complete functionality of all Coordination of Benefits (COB) processes, including the reconciliation of claims, membership, and financial records.

Key Responsibilities:

  • Utilize internal databases and resources, initiating sensitive communications with carriers, members, groups, providers, legal representatives, and governmental bodies to identify members eligible for additional coverage.
  • Assist members in enrolling in Medicare when they qualify.
  • Assess the primary coverage for each case by applying a detailed set of Primacy Rules in accordance with State and Federal Laws, including CMS Primacy and NAIC regulations, while comparing them to the benefits of members/groups.
  • Update the company's membership systems with findings from investigations related to claim coordination.
  • Ensure that appropriate forms are provided to facilitate members' enrollment in Medicare.
  • Analyze claim histories to pinpoint claims that require reconciliation, whether they have been processed or are pending, as well as those that were erroneously recovered.
  • Identify the correct formulas necessary for adjudicating affected claims, utilizing various COB Formulas applicable to different product types, in line with State and Federal Guidelines.

Required Qualifications:

  • A high school diploma or equivalent, along with a minimum of 2 years of experience in claims processing and customer service, plus 2 years of COB experience involving NAIC & CMS COB guidelines; or a combination of education and experience that provides equivalent expertise.

Preferred Skills and Experience:

  • Strong familiarity with WGS is highly preferred.
  • Previous experience in determining primacy with Medicare for group health plan members is advantageous.
  • This role is part of the MSP Demand team (Medicare reclamation) that supports group health plans.

Compensation and Benefits:

Elevance Health offers a competitive salary range for this position, along with a comprehensive benefits package that includes medical, dental, and vision coverage, 401(k) contributions, stock purchase options, and various incentive programs, all subject to eligibility requirements.

Company Overview:

Elevance Health is dedicated to enhancing lives and communities by simplifying healthcare. As a Fortune 25 company with a rich history in the healthcare sector, we seek individuals at all levels who are committed to making a positive impact on our members and the communities we serve.

Work Environment:

Elevance Health operates under a Hybrid Workforce Strategy, requiring associates to work at an Elevance Health location at least once a week, with specific expectations discussed during the hiring process. Candidates must reside within a reasonable commuting distance from an Elevance Health location.

Equal Opportunity Employer:

Elevance Health is an Equal Employment Opportunity employer, ensuring that all qualified applicants receive consideration for employment without regard to any protected status.

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