Claims COB Investigator

Role Description

Quartz is looking for an individual to investigate insurance information to coordinate benefits for claim processing. Processes claims, pends, and reports, as assigned in the claims processing system. Come find your spark at Quartz!

• Investigate other insurance information to coordinate benefits for claims processing
• Direct contact with members, CMS, or other health plans via telephone, letters, email, or portal submissions to obtain/verify other insurance information
• Determine primacy based on the other insurance obtained and confirm automatic filing order (AFO) is accurate
• Update Health Link with the other insurance information and ensure AFO is accurate
• Reconcile COB Smart, Discovery Health Partners, and Department of Health Services, to make sure other insurance and primacy determination is accurate
• Responsible to resolve COB primacy disputes
• Research external inquiries/complaints from members, providers, vendors, other health plan, governmental entities, etc. for dispute resolution and send claims to be adjusted
• Process claims, pends, and reports, as assigned, in the claims processing system
• Obtain all information needed to adjudicate claims appropriately through internal and external verbal and written correspondence
• Responsible for adhering to the principles of continuous quality improvement to ensure that our members receive the highest quality service
• Identify trends and opportunities for process improvement, including changes needed to the Claims Manual

Qualifications

• High school diploma or equivalency
• Three years of medical claims processing experience working in an office setting or one year of claims processing experience at Quartz consistently meeting quality and quantity goals
• Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home

Benefits

• Flexible and supportive work environment
• Full-time, remote, in-person or hybrid work environments available
• Ideal wage, based on skills and experience: $20.72 to $25.91, plus robust total rewards package

Company Description

Quartz offers an excellent benefit and compensation package, opportunity for professional growth and a professional culture built upon the foundations of Respect, Responsibility, Relationships, & Resourcefulness. To support a safe work environment, all employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity, Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified person with disability.