COB Representative

Mass General Brigham•Somerville, MA

1d•Remote

About The Position

The COB Representative investigates potential Coordination of Benefits (COB) recoveries using phone calls, questionnaires, claims, provider inquiries, and other systems. The role manages communications with internal and external customers and conducts research related to COB opportunities. It deals directly with providers, members, CMS, and other health plans regarding laws and statutes governing Coordination of Benefits. This remote position is available from most U.S. states and is scheduled Monday through Friday, 8:30 AM to 5:00 PM EST. Remote work requires a stable, secure, quiet, HIPAA-compliant workspace, which will be confirmed via Microsoft Teams video. The role is scheduled for 40 hours per week.

Requirements

High school diploma or equivalent.
At least 2–3 years of coordination of benefits, third-party liability, or other healthcare-related experience.
Strong customer service skills.
Knowledge of medical terminology.
Excellent communication skills.
Strong organizational skills.
Strong problem-solving skills.
A stable, secure, quiet, HIPAA-compliant workspace for remote work.

Responsibilities

Identify recovery opportunities within the department.
Review, research, and process COB claims for members with other insurance, including retractions and repayments, in accordance with desktop procedures, contractual requirements, and regulatory rules.
Reprocess claims for COB-termed members and ensure information is accurately added and maintained in QNXT.
Review, research, and resolve internal customer email inquiries about members’ claims or eligibility updates.
Review, research, and resolve Medicare Secondary Payer (MSP) cases according to Medicare guidelines and procedures, and communicate case status to the group and Sales Team when needed.
Coordinate recoveries with other insurers under federal regulations for services that cannot be recovered.
Process Credit Balance claims and refund checks, and validate claims retractions.
Process COB questionnaires for members and determine primary insurance in accordance with federal and state mandates.