Senior Claims Coordination Specialist

5 days ago


Tampa, Florida, United States Elevance Health Full time

About Elevance Health


Elevance Health is a leading health company dedicated to improving lives and communities – and making healthcare simpler. With a longstanding history in the healthcare industry, we are looking for talented individuals who share our passion for delivering exceptional service and support to our members.


Salary Range


We offer a competitive salary range of $19.04 to $34.27 per hour, depending on location and experience.



Job Description: eCOB Specialist I


The eCOB Specialist I plays a vital role in researching and investigating other coverage for all of our company's groups and members. This position requires a strong understanding of complex rules, laws, and contracts, as well as excellent communication and problem-solving skills.




  • Key Responsibilities:
  • Research and investigate other coverage for groups and members
  • Perform multi-complex functions and interpret complex rules, laws, and contracts
  • Ensure end-to-end functionality on every Coordination of Benefits (COB) function, including reconciliation of claims, membership, and accounting
  • Utilize internal queries and resource tools to identify members who are or should be enrolled in other coverage
  • Aid members in enrolling in Medicare when they are entitled
  • Update all membership system components with investigation results for claim coordination
  • Review claim history to reconcile processed, pended, or recovered claims
  • Identify correct formulas to adjudicate impacted claims using multiple COB Formulas for various product types, pursuant to State and Federal Guidelines


Requirements and Qualifications


To be successful in this role, you will require:




  • A high school diploma or equivalent and a minimum of 1 year of claims processing and/or customer service experience, or any combination of education and experience that provides an equivalent background
  • Strong knowledge of NAIC & CMS COB guidelines
  • Excellent oral and written communication skills, PC skills, database systems, and related software (word processing, spreadsheets, etc.)


Benefits and Culture


We offer a comprehensive benefits package, including a range of market-competitive total rewards, merit increases, paid holidays, Paid Time Off, and incentive bonus programs. Our culture is designed to advance our strategy, power our business outcomes, and drive shared success for our consumers, associates, communities, and business.



Work Arrangements


We operate in a Hybrid Workforce Strategy, requiring associates to work at least once per week at an Elevance Health location and potentially several times per week. Specific requirements and expectations for time onsite will be discussed during the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.



Equal Employment Opportunity


Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws.



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