Coordination of Benefits Specialist

Job Description

About the Role

COB Specialist

Full-Time/Regular

Remote

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Coordination of Benefits (COB) Specialist is responsible for optimizing COB recovery efforts by identifying and investigating health plan members for other insurance coverage. The COB Specialist is responsible for partnering with our providers and members to respond to and resolve incoming COB inquiries and appeals. The Specialist is expected to take complete responsibility for every interaction with a provider and a member by providing outstanding service. The Specialist is also responsible for accurate and timely processing of COB claims, completing activity reports, communicating COB policies to internal and external sources, and supporting the recovery efforts of the department.

Our Investment in You:

Full-time remote work

Competitive salaries

Excellent benefits

Key Functions/Responsibilities:

Responds to provider and member phone calls and correspondence including but not limited to claim adjustments requests, appeals, corrected claims, timely filings and projects

Investigates members for other insurance through phone calls, questionnaires, provider inquiries and claims in order to optimize savings to the Plan

Accurately processes COB claims in Facets, including retractions, denials, repayments and secondary balances

Processes all departmental reports in an accurate and timely manner and reports findings to the team lead and manager

Participates in departmental meetings and assists in the development of workflow and process improvements

Assists in internal departmental training programs on COB and participates in the training of new COB team members

Identifies additional methods for increased recoveries through interactions with internal and external customers

Qualifications:

Education:

Bachelor’s Degree in Business, Healthcare Administration or related fields; or an equivalent combination of education, training, and experience is required

Experience:

Four or more years of progressively responsible experience in a healthcare or managed care field required

Experience in COB claims processing, and experience in a Medicaid MCO setting highly preferred

Competencies, Skills, and Attributes:

Proficient PC skills including all Microsoft Office products required

Candidate must be able to multi-task and prioritize work

Must have excellent verbal and written communication skills, organizational skills and customer service skills

The COB Specialist must demonstrate initiative for process improvement and have the ability to provide direction and feedback to co-workers

Ability to work both as a team member and independently

Working Conditions and Physical Effort:

Ability to work OT during peak periods

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

Required Skills

In-depth knowledge of coordination of benefits (COB) and health insurance policies

Proficiency in claims processing and healthcare billing

Strong analytical and problem-solving skills

Excellent communication and interpersonal skills

Ability to interpret complex data and make informed decisions

Proficiency with health information systems and Microsoft Office Suite

Strong organizational skills with the ability to prioritize tasks

Detail-oriented with a focus on accuracy and quality

Ability to work independently and as part of a team

Familiarity with federal and state laws related to health insurance and COB

Adaptability to changing regulations and industry standards

Required Experience

Proven experience in coordination of benefits (COB) within a healthcare or insurance setting

Experience with claims adjudication and healthcare billing

Familiarity with health insurance coverage and policy interpretation

History of working with insurance carriers and healthcare providers to resolve COB issues

Experience maintaining accurate records and managing sensitive information

Demonstrated ability to comply with relevant laws and regulations

Prior experience working in a fast-paced, deadline-driven environment

Track record of effective communication with stakeholders at various levels

Experience in using health information systems and data analysis tools

Bachelor’s degree in healthcare administration, finance, or related field preferred