COB Specialist, Payment Integrity
Core
Investigate and verify proper payment of medical and pharmacy claims, create COB workflows, and drive audits to ensure correct reimbursement.
Role type
Senior IC Coordination of Benefits (COB) Specialist
Builds
COB workflows, audit processes, and payment integrity solutions
Domain
Health Insurance / Claims Processing
Required skills
Coordination of Benefits (COB) methodologies, claims processing, dual coverage analysis, data analysis, business workflow improvement, stakeholder collaboration
Preferred skills
SQL, pharmacy COB, healthcare claims organization experience, knowledge management
Technologies
SQL, Excel
Responsibilities
Investigate and verify proper payment of Oscar medical and pharmacy claims; Create new COB workflows and enhance existing ones; Analyze data to identify thematic areas of opportunity for COB solutions; Respond to internal and external inquiries and disputes regarding COB policies; Conduct root cause analysis on adverse claim outcomes; Collaborate with partners to scope, size, and prioritize COB items.
Seniority
Mid-Senior level, hands-on IC