Benefits Specialist

This is a fully remote position, open to applicants in Alaska, +7 more states.

📋 Description

• Investigate and establish the correct Coordination of Benefits (COB) for members possessing multiple health insurance plans.

• Examine insurance eligibility, policy coverage, and documentation to ensure the appropriate payer order.

• Communicate with insurance carriers, Medicare (CMS), employer groups, healthcare providers, and members via phone, email, fax, and mail to confirm coverage information.

• Research intricate healthcare eligibility issues and apply Medicare CMS and NAIC guidelines to ascertain primary and secondary coverage.

• Accurately document findings in company systems while maintaining thorough and detailed records.

• Review Explanation of Benefits (EOBs) and other insurance documents to support payment decisions.

• Process incoming COB correspondence and update eligibility records as necessary.

• Manage inbound and outbound calls concerning Coordination of Benefits inquiries.

• Achieve set productivity, quality, and turnaround time objectives.

• Ensure HIPAA compliance and adhere to all federal, state, and client regulations.

• Work collaboratively with colleagues while independently in a remote setting.

• Identify opportunities for enhancing processes, documentation, and communication.

⛳️ Requirements

• A minimum of 2 years of healthcare experience related to Coordination of Benefits (COB) in a provider, payer, or healthcare vendor context.

• 4+ years of experience in one or more of the following areas:

• - Insurance Verification

• - Medical Billing

• - Healthcare Claims Processing

• - Claims Auditing

• - Medical Reimbursement

• - Healthcare Data Analysis

• Proficient understanding of Coordination of Benefits (COB) guidelines.

• Knowledge of Medicare (CMS) regulations and NAIC Coordination of Benefits guidelines.

• Familiarity with medical terminology and healthcare eligibility processes.

• Strong investigative, research, and critical thinking abilities.

• Excellent verbal and written communication skills.

• Capability to articulate complex insurance information clearly and professionally.

• Strong customer service skills with the ability to communicate confidently with insurance carriers, providers, employer groups, and members.

• Experience in a production-driven environment while upholding high-quality standards.

• Strong organizational and multitasking skills.

• Proficiency in Microsoft Office (Word, Excel, and Outlook).

• Ability to work independently while effectively collaborating with a remote team.

🏝️ Benefits

• Health insurance coverage.

• Voluntary dental and vision programs.

• Life and disability insurance.

• Retirement savings plan.

• Paid holidays.

• Paid time off (PTO) or vacation and/or sick time.

• Eligible for benefits from day 1.