eCOB Specialist II
4 days ago
We are seeking an experienced eCOB Specialist II to join our team at Elevance Health. As a key member of our Claims Support team, you will play a critical role in ensuring the accurate and timely processing of claims.
Key Responsibilities- Research and investigate other coverage for all of our groups and members on multiple platforms.
- Perform complex functions and interpret complex rules, laws, and contracts.
- Accountable for end-to-end functionality on every Coordination of Benefits (COB) function, including reconciliation of claims, membership, and accounting.
- Utilize internal queries, internal resource tools, and initiate delicate phone calls to other carriers, members, groups, providers, attorneys, CMS, and Medicaid to identify members who are or should be enrolled in other coverage.
- Aide members in enrolling in Medicare when they are entitled.
- Determine 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's benefits.
- Update all of our membership system components with investigation results for claim coordination.
- Ensure correct forms are provided to assist members enrolling in Medicare.
- Review 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.
- Requires a HS diploma or equivalent and a minimum of 2 years of claims processing and customer service experience 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.
- Knowledge of WGS strongly preferred.
- Previous experience determining primacy with Medicare for group health plan members is preferred.
- This position is for the MSP Demand team (Medicare reclamation) supporting group health plans - CHB.
We offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution. The salary range for this position is $19.20 to $34.55, and the location is California, Colorado, District of Columbia (Washington, DC), Nevada, New York, and Washington State.
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eCOB Specialist II
2 days ago
Louisville, Kentucky, United States Elevance Health Full timeAbout the RoleWe are seeking an experienced eCOB Specialist II to join our team at Elevance Health. As a key member of our Claims Support team, you will play a critical role in ensuring the accurate and timely processing of claims.Key ResponsibilitiesResearch and investigate other coverage for all of our groups and members on multiple platforms.Perform...
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