COB Representative
About The Position
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. Job Summary The role is responsible for investigating potential recoveries for Coordination of Benefits through phone calls, questionnaires, claims, provider inquiries, and other systems as required. This incumbent will also be responsible for the management of communications with internal and external customers and a high level of research work related to the Coordination of Benefits opportunities. Deals directly with providers, members, CMS, and other health plans in the state and nationally regarding laws and statutes governing Coordination of Benefits.
Requirements
- High School Diploma or Equivalent required
- At least 2-3 years of coordination of benefits or third-party liability or other healthcare-related experience required
- Strong customer service skills.
- Knowledge of medical terminology.
- Excellent communication skills.
- High organization skills.
- Great problem-solving skills.
Responsibilities
- Responsible for identifying recovery opportunities within the Department.
- Review, research, and process all COB claims for members with other insurance, including retractions and repayments, according to desktop procedures, contractual requirements, and other regulatory rules.
- Responsible for reprocessing claims for COB termed members and ensuring information is added and maintained accurately in QNXT.
- Responsible for reviewing, researching, and resolving email inquiries from internal customers regarding members’ claims and/or eligibility updates.
- Responsible for reviewing, researching, and resolving Medicare Secondary Payer (MSP) cases according to Medicare guidelines and procedures. Actively communicate case status to the group and Sales Team when needed.
- Coordinate recoveries per federal regulations with other insurers for services unable to be recovered.
- Process Credit Balance claims, refund checks, and validate claim retractions.
- Process COB questionnaires to members and make determinations of primary insurance in accordance with federal and state mandates.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
