eCOB Specialist II - Newborn Benefits

Elevance Health•Atlanta, GA

2d•Remote

About The Position

The eCOB Specialist II is responsible for researching and investigating other coverage for all of the company's groups and members on multiple platforms. This role requires full proficiency in all key areas, performing multi-complex functions and interpreting complex rules, laws, and contracts. The specialist is accountable for end-to-end functionality on every Coordination of Benefits (COB) function, including the reconciliation of claims, membership, and accounting. This role enables associates to work virtually full-time, with flexibility for occasional in-office work and potential for alternate locations if candidates are within commuting distance. The position involves initiating communication with various entities to identify other coverage and ensuring members are correctly enrolled in programs like Medicare. It also requires determining primacy on cases using complex rules and updating membership systems. The associate must review claim history, identify claims needing reconciliation, and apply correct COB formulas according to State and Federal Guidelines. The role demands the ability to multitask in a fast-paced environment, handle various communication channels simultaneously, and maintain focus during extended periods of sitting. Strong communication, critical thinking, problem-solving, and empathy are essential. Associates will have a structured work schedule with potential for overtime or flexibility based on business needs.

Requirements

Requires a HS diploma or equivalent.
A minimum of 2 years of claims processing and customer service.
2 years COB experience that required using NAIC & CMS COB guidelines.
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.
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.

Nice To Haves

Newborn benefits experience strongly preferred.
WGS experience strongly preferred.
Strong organizational and time management skills preferred.

Responsibilities

Researching and investigating other coverage for all of the company's groups and members on multiple platforms.
Performing multi-complex functions and interpreting complex rules, laws, and contracts.
Accountable for end-to-end functionality on every Coordination of Benefits (COB) function including reconciliation of claim, membership and accounting.
Utilizing internal queries, internal resource tools, and initiating delicate phone calls to other carriers, members, groups, providers, attorneys, CMS, and Medicaid to identify members who are or should be enrolled in other coverage.
Aiding members in enrolling in Medicare when they are entitled.
Determining primacy on each case using a complex set of Primacy Rules as mandated by State and Federal Laws, such as CMS Primacy and NAIC rules and comparing them against the member/groups benefits.
Updating all of the company's membership system components with investigation results for claim coordination.
Ensuring correct forms are provided to assist members enrolling in Medicare.
Reviewing claim history to identify claims requiring reconciliation, whether processed or pended, as well as recovered in error.
Identifying the correct formulas to adjudicate impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines.
Handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
Performing other duties as assigned.