Carelon Coordination of Benefits (COB) - Investigator II
Core
Conducting thorough investigations into potential other coverages to determine primacy and ensure seamless coordination of benefits across multiple vendor clients, employer groups, and government lines of business.
Role type
Senior IC claims investigation specialist (COB)
Builds
Accurate claims adjudication and payment reconciliation for healthcare payers
Domain
Healthcare insurance and claims processing
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Multi-system data analysis, claims adjudication, regulatory compliance (NAIC, CMS, MSP, ERISA), stakeholder communication, membership data management, payment reconciliation, SLA adherence
Preferred skills
COB investigation experience, Advanced Negotiation & Dispute Resolution, SQL/data analysis tools, Microsoft Office Suite proficiency
Technologies
COB Smart, HEW, Microsoft Office Suite, SQL
Responsibilities
Conduct in-depth COB investigations to establish primary and secondary coverage; Analyze comprehensive data sources to verify coverage and resolve discrepancies; Initiate and manage sensitive communications with stakeholders including insurance carriers and CMS; Ensure accuracy in membership data updates; Identify and rectify incorrectly paid claims; Maintain compliance with vendor SLAs and federal/state guidelines
Seniority
Mid-level, hands-on IC