Processor, Coordination of Benefits
Core
Administrative processor supporting coordination of benefits to ensure accurate medical expense and premium reimbursement processing.
Role type
Administrative processor (coordination of benefits)
Builds
Accurate claims processing and premium reimbursement records
Domain
Healthcare administration / Insurance coordination
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Data entry, Claims processing, Insurance record management, Medicare Secondary Payer (MSP) knowledge, End-Stage Renal Disease (ESRD) processes, CMS communication, Ticket tracking, Microsoft Office Suite, Multi-tasking, Deadline management
Preferred skills
Healthcare industry experience, Coordination of benefits familiarity, Health insurance process knowledge
Responsibilities
Provide telephone, administrative, and data-entry support to the coordination of benefits team. Support daily coordination of benefits review activities that directly affect medical expenses and premium reimbursement. Coordinate benefits information with other insurance carriers responsible for payment. Contact insurance companies by phone or use their online portals to validate state, vendor, and internal coordination-of-benefits leads. Research and verify other insurance coverage information to support accurate claims processing. Update other insurance records within the claims transactional system. Maintain accurate information in the coordination-of-benefits tracking database. Ensure insurance records are updated promptly and accurately based on validated information. Contact the Centers for Medicare and Medicaid Services (CMS) when required to support coordination-of-benefits activities. Coordinate with designated company contacts to submit and track tickets related to premium restoration. Support Medicare Secondary Payer (MSP) and End-Stage Renal Disease (ESRD) premium restoration activities. Follow established procedures for documenting insurance and benefits information. Communicate with internal and external stakeholders to obtain or clarify coverage information. Manage multiple administrative tasks and requests while meeting internal deadlines. Maintain accurate documentation and records throughout the coordination-of-benefits process.
Seniority
Entry-level to Junior, hands-on IC