eCOB Specialist II

ECOB Specialist II

This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

The ECOB Specialist II is responsible for researching and investigating other coverage for all of the company's groups and members on multiple platforms. Fully proficient in all key areas; performs multi complex functions and interprets complex rules, laws and contracts. Accountable for end-to-end functionality on every Coordination of Benefits(COB) function including reconciliation of claim, membership and accounting.

How you will make an impact:

• Utilizes internal queries, internal resource tools, must initiate delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS and Medicaid and report to identify members who are or should be enrolled in other coverage.
• Aides members in enrolling in Medicare when they are entitled.
• Determines 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/groups benefits.
• Updates all of the company's membership system components with investigation results for claim coordination.
• Ensures correct forms are provided to assist members enrolling in Medicare.
• Reviews 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 adjudicates impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines.
• Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
• Additional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
• Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.
• Performs other duties as assigned.

Minimum Qualifications:

• Requires a HS diploma or equivalent and a minimum of 2 years of claims processing and customer service 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.

Preferred Skills, Capabilities and Experiences:

• Strong organizational and time management skills preferred