COB Claims Examiner

Blue Cross of Idaho•Bozeman, MT

13d•$19 - $27•Onsite

About The Position

Blue Cross of Idaho is seeking a COB Claim Examiner to utilize claims systems and established resources to determine coordination of benefits and potential claim overpayments for members covered by more than one health coverage. Determine whether to return, deny or pay claims following organizational policies and procedures.

Requirements

1-year relevant experience
Basic knowledge of Medicare Secondary Payer (MSP) rules and Other Health Insurance (OHI) processing.
Knowledge of medical terminology
Ability to complete assigned individual tasks within scope
Ability to follow detailed policies, guidelines, and regulatory requirements.
Verbal & Written Communication

Responsibilities

Review and analyze claims to determine proper Coordination of Benefits (COB), including primary and secondary payer responsibility
Apply Medicare COB rules, including Medicare Secondary Payer (MSP) guidelines and Other Health Insurance (OHI) determinations.
Identify situations where Medicare is primary vs. secondary based on MSP provisions (e.g., working aged, ESRD, disability, liability, no-fault, and workers’ compensation cases).
Evaluate and validate OHI information to ensure accurate claims processing and reimbursement.
Request and verify eligibility and coverage information from members, providers, and other insurance carriers.
Collaborate with internal teams (e.g., Payment Integrity, Recovery, Customer Service) to resolve claims issues.
Assist with recovery and adjustment of claims when incorrect COB determinations result in overpayment.
Process claims accurately within established productivity and quality standards.