COB Representative

United States, Massachusetts, Somerville 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. Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. 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 claim retractions. Process COB questionnaires to members and make determinations of primary insurance in accordance with federal and state mandates. Education High School Diploma or Equivalent required Experience 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. Working Conditions This is a remote role that can be done from most US states. This is a Monday-Friday role with standard business hours (in Eastern time). Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. #J-18808-Ljbffr Mass General Brigham Health Plan