Coordination of Benefits (COB) Analyst - Jefferson Health Plan

Jefferson Health Plans • Philadelphia, PA

9d

About The Position

The Coordination of Benefits (COB) Analyst is responsible for identifying, investigating, and resolving potential third-party liability and overlapping insurance coverage. This role supports accurate claims payment by determining the correct order of benefits between payers, updating COB records, and initiating claim rework when appropriate. The position involves moderate to complex COB investigations requiring independent judgment, analytical skills, and consistent application of regulatory and operational guidelines.

Requirements

• High School Diploma/GED with relevant experience required
• 2 years of experience in healthcare insurance operations, such as COB, TPL, claims processing, enrollment, or payment integrity required

Nice To Haves

• Associate’s Degree in healthcare related field or Bachelor’s Degree in healthcare related field preferred

Responsibilities

• Conducts outbound and inbound outreach, as needed, to members, providers, employers, or other insurers to obtain, validate, or clarify other insurance. coverage information in support of COB determinations.
• Reviews member eligibility and coverage information to identify overlapping insurance coverage.
• Determines the correct order of benefits between payers in accordance with CMS Medicare Secondary Payer (MSP) rules and NAIC commercial Coordination of Benefits guidelines.
• Performs moderate to complex COB investigations involving multiple coverages, conflicting data, or overlapping eligibility periods.
• Accurately updates COB and coverage records in core systems to support proper claims routing and adjudication.
• Initiates claim reprocessing, cost avoidance, or recovery actions when COB determinations impact previously processed claims.
• Responds to COB-related claim appeals, inquiries, and research requests by reviewing coverage determinations and supporting documentation.
• Documents investigation findings clearly and thoroughly while meeting established productivity, quality, and timeliness standards.

Benefits

• Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED