Coordination of Benefits

Centene Corporation•Northampton, MA

3d•$19 - $33

About The Position

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Shifts will be Monday through Friday working an 8 hour shift between 7am - 5pm CST. Position Purpose: Ensure accuracy of payments and/or denials related to COB or overpayment recovery processes and are made in accordance with company protocols and procedures. Using multiple sources, this position researches Coordination of Benefits (COB) including Explanation of Benefit (EOB) documentation for potential dual coverage by other health insurance companies for all subscribers, spouses and affected dependents and determines which insurance is prime. COB research extends to all coverage offered by all lines of business and platforms. Calls hospitals, insurance companies, medical groups and/or members requesting other insurance information as it pertains to dual coverage, eligibility and termination dates of coverage. Researches various COB information from lead sources including but not limited to Member Enrollment Forms, returned member request letters, prior claims, authorizations and Call Center Contacts. Makes COB determinations in accordance to COB guidelines (NAIC, CMS, DMHC, DOI or other resources). Updates the COB master file with other insurance information. Sends correspondence to members requesting COB information. Identifies need to re-adjudicate claims for members when Centene is secondary. Role includes transactional duties related to provider overpayment recovery processes as assigned. Performs other duties as assigned. Complies with all policies and standards.

Requirements

High School Diploma or equivalent required.
1+ years experience in health insurance industry; prior experience in claims working with coordination of benefits processes preferred and or one year experience in a customer service environment required.
1+ years experience using computers with Microsoft Office proficiency required.
1+ years experience with Medicaid or Medicare claims preferred.

Nice To Haves

Associate's Degree preferred.
prior experience in claims working with coordination of benefits processes
1+ years experience with Medicaid or Medicare claims

Responsibilities

Ensure accuracy of payments and/or denials related to COB or overpayment recovery processes
Research Coordination of Benefits (COB) including Explanation of Benefit (EOB) documentation for potential dual coverage
Determine which insurance is prime
Call hospitals, insurance companies, medical groups and/or members requesting other insurance information
Research various COB information from lead sources
Make COB determinations in accordance to COB guidelines
Update the COB master file with other insurance information
Send correspondence to members requesting COB information
Identify need to re-adjudicate claims for members when Centene is secondary
Perform transactional duties related to provider overpayment recovery processes as assigned
Perform other duties as assigned
Comply with all policies and standards