COB Specialist
: Job Details :

Job Description - COB Specialist (2400554)ResponsibilitiesCOB Specialist IResearches and responds to inquiries/issues to ascertain specifics of multiple health insurance coverages for members and dependents. Contacts membership, providers, and other insurance companies to gather coordination of benefits (COB) data. Determines source of problem, impact to customers, and resolution.Generates reports in various systems to access daily inventory.Identifies and determines appropriate conditions to apply.Researches, resolves, and responds to moderately complex and time sensitive inquiries using both internal and external systems.Reviews and approves appropriate payment order for customer service inquiries routed to the Coordination of Benefits (COB) department for investigation and file update.Reviews and approves appropriate payment order for claims pended to the Coordination of Benefits (COB) department for investigation and file update.Maintains member COB files from returned correspondence/questionnaires.Participates in departmental meetings and assists in the development of workflow and process improvements.Answers phone inquiries regarding COB from internal customers such as customer service, operations, and other insurance companies.Performs other duties as assigned.Sr. COB SpecialistPerforms research to ascertain specifics of other coverage for members and dependents via correspondence and/or direct communication with members, other insurers, providers, sales representatives, Membership and other internal departments. Applies knowledge of regulations pertaining to order of benefit determination. Loads member files with the appropriate coding to reflect accurate status for a given time period.Reviews claims pended to the Coordination of Benefits (COB) department for investigation and file update.Researches and responds to Contact Online Reporting System (CORS).Maintains member COB files from returned correspondence/questionnaires.Performs additional research as necessary (ad hoc letters, phone calls) to assure complete and accurate file maintenance per member.Updates member files from monthly production maintenance reports and/or ad hoc query reports for group specific issues.Performs other duties as assigned.QualificationsCOB Specialist IEducation and Experience:Bachelors' Degree in Business or Healthcare Administration or related field preferred, but will consider collective experience, training and education.3 years of relevant experience in health insurance or the health care industry.Technical Skills and Knowledge:Knowledge of health insurance products and services, benefits.Intermediate Microsoft Office and document workflow management systems skills.Sr. COB SpecialistEducation and Experience:Bachelors' Degree in Business or Healthcare Administration or related field preferred, but will consider collective experience, training and education.1 year experience as a COB Specialist or equivalent 3 years experience in health insurance claims or customer service operations.Professional Certification(s):Certified Professional Coder (preferred)Technical Skills and Knowledge:Knowledge of National Association of Insurance Commissioners (NAIC) and Ohio Department of Insurance (ODI) Rules of Order, ASO requirements and COBRA, Medicare and Medicaid rules.Strong Knowledge of COB concepts and company policies related to COB administration.Intermediate to advanced Microsoft Office and internal systems (TOPPS OnBase, Membership?) skills.#J-18808-Ljbffr