Coordination of Benefits Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct investigations to ascertain the proper Coordination of Benefits (COB) for members enrolled in multiple health insurance plans.

• Evaluate insurance eligibility, policy coverage, and associated documentation to confirm the correct order of payers.

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

• Investigate complex healthcare eligibility matters and utilize Medicare CMS and NAIC guidelines to identify primary and secondary coverage.

• Accurately document findings in company systems while keeping comprehensive and detailed records.

• Review Explanation of Benefits (EOBs) and additional insurance documents to assist in payment decisions.

• Manage incoming COB correspondence and refresh eligibility records as required.

• Address inbound and outbound calls related to Coordination of Benefits queries.

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

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

• Work independently in a remote setting while collaborating with team members.

• Identify areas for improvement in processes, documentation, and communication.

⛳️ Requirements

• At least 2 years of experience in healthcare focusing on Coordination of Benefits (COB) within a provider, payer, or healthcare vendor setting OR 4+ years in Insurance Verification, Medical Billing, Healthcare Claims Processing, Claims Auditing, Medical Reimbursement, or Healthcare Data Analysis.

• Familiarity with Coordination of Benefits (COB) guidelines.

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

• Comprehension of medical terminology and healthcare eligibility procedures.

• Exceptional investigative, research, and critical thinking abilities.

• Strong verbal and written communication skills.

• Capability to clearly and professionally explain complex insurance information.

• Excellent customer service skills with the confidence to communicate with insurance carriers, providers, employer groups, and members.

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

• Strong organizational skills and the ability to multitask effectively.

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

• Capacity to work independently while effectively collaborating in a remote team.

• Must reside in a qualifying U.S. state or municipality where the compensation structure aligns with applicable wage regulations; hiring is not available in AK, CA, CT, HI, MA, IL, MT, NY, and certain listed metro areas.

🏝️ Benefits

• Fully remote position.

• Flexible Monday-Friday work schedule.

• No weekend work required.

• Competitive starting salary.

• Supportive team environment.

• Eligibility for benefits starting on day 1.

• Comprehensive health insurance coverage.

• Optional dental and vision programs.

• Life and disability insurance offerings.

• Retirement savings plan.

• Paid holiday time.

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

• Potential for bonuses or incentives based on business needs.