Coordination of Benefits Specialist

Conduent•Remote, CA

3d•$39,960 - $46,200•Remote

About The Position

Are you experienced in Coordination of Benefits (COB), Medicare, insurance verification, healthcare claims, or medical billing? We're looking for a detail-oriented healthcare professional who enjoys solving complex insurance coverage issues and working in a fast-paced remote environment. As a Coordination of Benefits (COB) Specialist, you'll investigate insurance coverage, determine the correct order of benefits, communicate with insurance carriers and healthcare providers, and ensure claims are processed accurately while remaining compliant with Medicare and federal regulations. If you have strong analytical skills, enjoy researching insurance eligibility, and take pride in delivering accurate, high-quality work, we'd love to hear from you.

Requirements

Minimum of 2 years of healthcare experience involving Coordination of Benefits (COB) in a provider, payer, or healthcare vendor environment OR 4+ years of experience in one or more of the following: Insurance Verification, Medical Billing, Healthcare Claims Processing, Claims Auditing, Medical Reimbursement, Healthcare Data Analysis.
Working knowledge of Coordination of Benefits (COB) guidelines.
Knowledge of Medicare (CMS) regulations and NAIC Coordination of Benefits guidelines.
Understanding of medical terminology and healthcare eligibility processes.
Strong investigative, research, and critical thinking skills.
Excellent verbal and written communication skills.
Ability to explain complex insurance information clearly and professionally.
Strong customer service skills with the ability to communicate confidently with insurance carriers, providers, employer groups, and members.
Experience working in a production-driven environment while maintaining high-quality standards.
Strong organizational and multitasking abilities.
Proficiency with Microsoft Office (Word, Excel, and Outlook).
Ability to work independently while collaborating effectively with a remote team.

Responsibilities

Investigate and determine the correct Coordination of Benefits (COB) for members with multiple health insurance plans.
Review insurance eligibility, policy coverage, and documentation to verify the proper payer order.
Contact insurance carriers, Medicare (CMS), employer groups, healthcare providers, and members by phone, email, fax, and mail to validate coverage information.
Research complex healthcare eligibility issues and apply Medicare CMS and NAIC guidelines to determine primary and secondary coverage.
Document findings accurately in company systems while maintaining complete and detailed records.
Review Explanation of Benefits (EOBs) and other insurance documentation to support payment determinations.
Process incoming COB correspondence and updating eligibility records as needed.
Handle inbound and outbound calls related to Coordination of Benefits inquiries.
Meet established productivity, quality, and turnaround time goals.
Maintain HIPAA compliance and adhere to all federal, state, and client requirements.
Collaborate with teammates while working independently in a remote environment.
Identify opportunities to improve processes, documentation, and communication.