eCOB Specialist I

Elevance Health • Norfolk, VA

5d • Hybrid

About The Position

eCOB Specialist I Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered if candidates reside within a commuting distance from an office. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The eCOB Specialist I is responsible for researching and investigating other coverage for all of the company's groups and members. It performs multi complex functions and interprets complex rules, laws and contracts. The role is accountable for end-to-end functionality on every Coordination of Benefits (COB) function including reconciliation of claim, membership, and accounting. How you will make an impact: Utilizes internal queries, internal resource tools, must initiate delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS, and Medicaid and report to identify members who are or should be enrolled in other coverage. Aides members in enrolling in Medicare when they are entitled. Updates all of the company's membership system components with investigation results for claim coordination. Ensures correct forms are provided to assist members enrolling in Medicare. Reviews claim history to reconcile processed, pended, or recovered in any error. Associate must identify the correct formulas in order to adjudicate impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines. Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers. Additional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts. Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary. Performs other duties as assigned.

Requirements

• Requires a HS diploma or equivalent and a minimum of 1 year of claims processing and/or customer service and a minimum of 1 year coordination of benefits experience; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

• Knowledge of NAIC & CMS COB guidelines strongly preferred.
• Excellent oral and written communication skills, PC skills, database system, and related software (word processing, spreadsheets, etc.) strongly preferred.

Responsibilities

• Utilizes internal queries, internal resource tools, must initiate delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS, and Medicaid and report to identify members who are or should be enrolled in other coverage.
• Aides members in enrolling in Medicare when they are entitled.
• Updates all of the company's membership system components with investigation results for claim coordination.
• Ensures correct forms are provided to assist members enrolling in Medicare.
• Reviews claim history to reconcile processed, pended, or recovered in any error.
• Associate must identify the correct formulas in order to adjudicate impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines.
• Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
• Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment
• Performs other duties as assigned.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

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