COB Representative at Partner's Healthcare in Somerville, Massachusetts

Job Title

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

The role is responsible for investigating potential recoveries for Coordination of Benefits through phone calls, questionnaires, claims, provider inquiries, and other systems as required. This incumbent will also be responsible for the management of communications with internal and external customers and a high level of research work related to the Coordination of Benefits opportunities. Deals directly with providers, members, CMS, and other health plans in the state and nationally regarding laws and statutes governing Coordination of Benefits.

Essential Functions:

• Responsible for identifying recovery opportunities within the Department.
• Review, research, and process all COB claims for members with other insurance, including retractions and repayments, according to desktop procedures, contractual requirements, and other regulatory rules.
• Responsible for reprocessing claims for COB termed members and ensuring information is added and maintained accurately in QNXT.
• Responsible for reviewing, researching, and resolving email inquiries from internal customers regarding members' claims and/or eligibility updates.
• Responsible for reviewing, researching, and resolving Medicare Secondary Payer (MSP) cases according to Medicare guidelines and procedures. Actively communicate case status to the group and Sales Team when needed.
• Coordinate recoveries per federal regulations with other insurers for services unable to be recovered.
• Process Credit Balance claims, refund checks, and validate claims retractions.
• Process COB questionnaires to members and make determinations of primary insurance in accordance with federal and state mandates.

Qualifications:

• High School Diploma or Equivalent required
• At least 2-3 years of coordination of benefits or third-party liability or other healthcare-related experience required

Knowledge, Skills, and Abilities:

• Strong customer service skills.
• Knowledge of medical terminology.
• Excellent communication skills.
• High organization skills.
• Great problem-solving skills.

Additional Job Details (if applicable):

• This is a remote role that can be done from most US states
• The schedule for this position is Monday through Friday, 8:30 AM to 5:00 PM EST

Pay Range: $22.22 - $31.71/Hourly Grade 4

EEO Statement: Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.