COB Coordinator

• Analyze, process, research and adjudicate claims that involve other insurance carriers.
• Process and monitor COB claims according to CMS guidelines.
• Investigates members for other insurance through phone calls and correspondence but not limited to claim adjustment requests or appeals.
• Responsible for send and monitor questionnaires / letter sent to members and providers.
• Responsible for timely processing of COB claims.
• Maintains quality standards in all research and adjustment functions.
• Enter claims or verify data entry for accuracy and completeness.
• Uses online policies and procedures to ensure accuracy in claims processing.
• Acts in liaison to providers and members for special claims handling.
• Contributes to team effort by accomplishing related results as needed.
• Communicates effectively with other professional and support staff in order to achieve positive customer outcomes.
• Promotes and contributes to a positive, problem-solving environment.
• Complies with company policies and procedures and maintains confidentiality of customer medical records in accordance with state and federal laws.
• Ensures compliance with all HIPAA, OSHA, and other federal, state, and local regulations.
• Participates in meetings, training and in-service education, as required.
• Performs other duties as assigned.

Qualifications:

• Excellent oral and written communication skills
• 1 – 3 years of Health claims processing experience
• Working knowledge of COB and MSP preferably
• Working knowledge of medical terminology
• Working knowledge of current Medicare Advantage operational and regulatory guidelines established by CMS, AHCA and other federal and state regulatory guidelines.
• Excellent organizational skills
• Ability to work well under pressure in difficult situations
• Bilingual: English / Spanish (Required)

Note:  This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s).  Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.   

No Third Party Agencies or Submissions Will Be Accepted.