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eCOB Coordination Specialist II
2 months ago
Job Overview
Position: eCOB Specialist II
Work Arrangement: Hybrid, within 50 miles of an Elevance Health Pulse Point location.
Working Hours: Monday - Friday, 6am - 6pm EST
The eCOB Specialist II plays a crucial role in the assessment and verification of alternative coverage for the company's members and groups across various platforms. This position requires a comprehensive understanding of complex functions and the ability to interpret intricate regulations, laws, and agreements. The specialist is responsible for the complete lifecycle of Coordination of Benefits (COB) activities, including the reconciliation of claims, membership, and financial records.
Key Responsibilities:
- Leverage internal databases and resources, initiating sensitive communications with other insurance carriers, members, groups, providers, legal representatives, and regulatory bodies to identify members eligible for additional coverage.
- Assist members in the enrollment process for Medicare when they qualify.
- Assess the primary coverage for each case using a detailed set of Primacy Rules as dictated by State and Federal regulations, including CMS Primacy and NAIC guidelines, while comparing these against the benefits of the member or group.
- Update the company’s membership systems with findings from investigations related to claim coordination.
- Ensure that appropriate documentation is provided to facilitate member enrollment in Medicare.
- Analyze claim histories to pinpoint claims that require reconciliation, whether they are processed or pending, as well as those recovered in error.
- Identify the correct methodologies to adjudicate affected claims, utilizing various COB formulas tailored to different product types, in accordance with State and Federal regulations.
Required Qualifications:
- A high school diploma or equivalent is required, along with a minimum of 2 years of experience in claims processing and customer service, and 2 years of COB experience utilizing NAIC & CMS COB guidelines; or any combination of education and experience that would provide equivalent expertise.
Preferred Skills and Experience:
- 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) supporting group health plans.
Compensation and Benefits:
For candidates working in person or remotely, the salary range for this position is $19.20 to $34.55. Elevance Health provides a comprehensive benefits package, including incentive programs, equity stock purchase options, and 401k contributions (subject to eligibility requirements). The salary offered is based on various legitimate, non-discriminatory factors established by the company.
Company Overview:
Elevance Health is committed to enhancing lives and communities while simplifying healthcare. As a Fortune 25 organization with a rich history in the healthcare sector, we seek leaders at all levels who are dedicated to making a positive impact on our members and the communities we serve.
Work Environment:
Elevance Health fosters a culture aimed at advancing our strategic goals while promoting personal and professional growth for our associates. Our core values and behaviors are fundamental to our culture, driving our success for consumers, associates, communities, and the business.
Elevance Health operates under a Hybrid Workforce Strategy, requiring associates to work at an Elevance Health location at least once per week unless specified otherwise. Candidates must reside within 50 miles or a 1-hour commute of a relevant Elevance Health location.
Elevance Health is an Equal Employment Opportunity employer, ensuring that all qualified applicants receive consideration for employment without regard to any protected status.
