eCOB Specialist II, III – Newborn Benefits

Role Overview

• This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy.
• Responsible for researching and investigating other coverage for all of the company's groups and members on multiple platforms.
• Fully proficient in all key areas; performs multi complex functions and interprets complex rules, laws and contracts.
• Accountable for end-to-end functionality on every Coordination of Benefits(COB) function including reconciliation of claim, membership and accounting.
• Utilizes internal queries, internal resource tools, must initiate delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS and Medicaid and report to identify members who are or should be enrolled in other coverage.
• Aides members in enrolling in Medicare when they are entitled.
• Determines primacy on each case using a complex set of Primacy Rules as mandated by State and Federal Laws, such as CMS Primacy and NAIC rules and comparing them against the member/groups benefits.
• Updates all of the company's membership system components with investigation results for claim coordination.
• Ensures correct forms are provided to assist members enrolling in Medicare.
• Reviews claim history to identify claims requiring reconciliation, whether processed or pended, as well as recovered in error.
• Associate must identify the correct formulas in order to adjudicates impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines.
• Expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.

Requirements

• eCOB Specialist II: Requires a HS diploma or equivalent and a minimum of 2 years of claims processing and customer service and 2 years COB experience that required using NAIC & CMS COB guidelines; or any combination of education and experience which would provide an equivalent experience.
• eCOB Specialist III: Requires a HS diploma or equivalent and a minimum of 3 years of claims processing and customer service and 3 years COB experience that required using NAIC & CMS COB guidelines; or any combination of education and experience which would provide an equivalent background.
• Newborn benefits experience strongly preferred
• WGS experience strongly preferred
• Strong organizational and time management skills preferred

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources