eCOB Specialist II
Core
Investigates coverage for company groups and members across multiple platforms to determine primacy and coordinate benefits, ensuring correct Medicare enrollment and claim reconciliation.
Role type
Claims Support Specialist (Coordination of Benefits)
Builds
Accurate claim adjudication and member enrollment status for health insurance plans
Domain
Health Insurance / Claims Administration
Deliverable
client delivery
Required skills
NAIC & CMS COB guidelines, complex rule interpretation, multi-platform investigation, claim reconciliation, Medicare enrollment determination, primacy rule application, form management, multi-tasking in high-pressure environments
Preferred skills
WGS experience, strong organizational and time management skills
Technologies
Internal queries, internal resource tools, digital tools and platforms
Responsibilities
Initiate phone calls to carriers, members, groups, providers, attorneys, CMS, and Medicaid to identify other coverage; determine primacy using State and Federal laws; update membership system components with investigation results; review claim history for reconciliation; apply COB formulas to adjudicate impacted claims; assist members in enrolling in Medicare.
Seniority
Individual Contributor, Non-Management