Claims Coordination of Benefits (COB) Analyst
About The Position
The Claims Coordination of Benefits (COB) Analyst plays a critical role in ensuring payment accuracy by identifying, analyzing, and coordinating benefits across multiple payers. This position supports the organization’s payment integrity initiatives by preventing improper payments, identifying overpayments, and supporting recovery efforts related to COB discrepancies. The Senior Analyst is responsible for interpreting COB rules, resolving complex claim issues, and validating payer hierarchy to determine accurate financial liability. They collaborate closely with claims, recovery, subrogation, and vendor management teams to drive COB-related process improvements and reduce waste. This role also supports audit responses, regulatory compliance, and special projects that impact overall claims accuracy and payment integrity performance.
Requirements
- In-depth understanding of COB processes, claim adjudication, and payer coordination rules
- Proven experience supporting or working within a Payment Integrity department
- Strong investigative and data analysis skills, including use of Excel and SQL
- Working knowledge of CARCs, RARCs, and overpayment recovery workflows
- 3–5+ years in COB analysis, claims operations, or payment integrity at a health plan or TPA
- Experience with pre-pay and post-pay integrity controls, audit response, and provider recovery
- Strong knowledge of federal and state regulations affecting COB and improper payment recovery
Nice To Haves
- Familiarity with claims platforms such as HealthEdge, Facets, or QNXT
Responsibilities
- Conduct in-depth COB analysis to prevent and recover incorrect payments
- Apply CMS, NAIC, ERISA, and Medicare Secondary Payer (MSP) rules to determine primary/secondary liability
- Identify trends and root causes of COB payment errors; propose solutions to enhance payment integrity
- Collaborate with Payment Integrity and SIU teams to resolve claims flagged for COB issues or FWA risk
- Monitor COB-related metrics and KPIs to support operational and compliance goals
- Collaborate with claims and adjustments teams on operational workflows to ensure COB accuracy and reduce rework and member/provider abrasion
Benefits
- Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.)
- $0 copays and $0 deductibles (with completion of our Baseline Visit )
- Preventive and primary care built in
- Mental health support (Rula, Televero, Two Chairs, Recovery Unplugged)
- One-on-one care navigation
- Chronic condition programs (diabetes, weight, hypertension)
- Maternity and family planning support
- 24/7/365 Curative Telehealth
- Pharmacy benefits
- Comprehensive dental and vision coverage
- Employer-provided life and disability coverage with additional supplemental options
- Flexible spending accounts
- Flexible work options: remote and in-person opportunities
- Generous PTO policy plus 11 paid annual company holidays
- 401K for full-time employees
- Generous Up to 8–12 weeks paid parental leave, based on role eligibility.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
