eCOB Specialist II - Newborn Benefits

Elevance Health•Tampa, FL

7d•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 is fully proficient in all key areas and performs multi-complex functions, interpreting complex rules, laws, and contracts. The specialist is accountable for end-to-end functionality on every Coordination of Benefits (COB) function, including reconciliation of claims, membership, and accounting. The role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. 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. 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.

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
Any combination of education and experience which would provide an equivalent experience.

Nice To Haves

Federal/State newborn benefits experience preferred
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

Responsibilities

Utilizes internal queries, internal resource tools, and must initiate delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS, and Medicaid to identify members who are or should be enrolled in other coverage.
Aides members in enrolling in Medicare when they are entitled.
Determines 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.
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 identify claims requiring reconciliation, whether processed or pended, as well as recovered in error.
Identifies the correct formulas in order to adjudicates impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines.
Handles calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
Maintains focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment.
Performs other duties as assigned.