eCOB Specialist I

1 week ago


Cincinnati, Ohio, United States Elevance Health Full time

Job Summary:

The eCOB Specialist I is a critical role within our organization, responsible for ensuring seamless coordination of benefits for our members. This position requires a high level of attention to detail, excellent communication skills, and the ability to navigate complex rules and regulations.

Key Responsibilities:

  • Research and investigate other coverage for all company groups and members, ensuring accurate and timely processing of claims.
  • Perform multi-complex functions, interpreting complex rules, laws, and contracts to ensure compliance and accuracy.
  • 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.
  • Update all company membership system components with investigation results for claim coordination.
  • Ensure correct forms are provided to assist members enrolling in Medicare.
  • Review claim history to reconcile processed, pended, or recovered in any error.
  • Associate must identify the correct formulas to adjudicate impacted claims, using multiple COB formulas for various product types, pursuant to State and Federal Guidelines.

Requirements:

  • Requires a HS diploma or equivalent and a minimum of 1 year of claims processing and/or customer service and a minimum of 1 year coordination of benefits experience; or any combination of education and experience which would provide an equivalent background.
  • Knowledge of NAIC & CMS COB guidelines strongly preferred.
  • Excellent oral and written communication skills, PC skills, database system, and related software (word processing, spreadsheets, etc.) strongly preferred.

Work Environment:

This role is a non-management, non-exempt position, working a 1st shift schedule. The salary range for this position is $19.04 to $34.27, and the company offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution.



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