Job Description
- Job Description:
- Investigate and validate other insurance coverage, resolving conflicting eligibility information.
- Establish the correct order of liability (primary vs. secondary payer) to prevent and recover improper claim payments.
- Perform hands-on casework in a high-volume environment including outreach, documentation, and system updates.
- Apply analytical skills to interpret claims and eligibility data, identify trends, and recommend process improvements for COB program.
- Requirements:
- Bachelor’s Degree and/or one (1) year of related healthcare experience (e.g., COB/TPL, eligibility, claims operations, billing, recovery, or payment integrity).
- Minimum of one (1) year of experience performing COB investigations and/or payment integrity casework, including independent ownership of moderate-to-complex inventories.
- Minimum of one (1) year of experience performing data analytics with large data sets.
- Minimum of one (1) year of experience using working knowledge of coordination of benefits rules, primary/secondary payer logic, coverage hierarchy, and order-of-liability concepts; understanding of CMS and NAIC guidance as applicable.
- Comfortable navigating multiple systems, portals, and payer interfaces.
- Ability to maintain confidentiality and comply with HIPAA and data security standards.
Benefits:
Apply Now
Apply Now