eCOB Specialist II - Newborn Benefits
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 virtual role offers maximum flexibility and autonomy, with the exception of required in-person training sessions, promoting productivity and work-life integration. Candidates must be within a reasonable commuting distance from the posting location(s) unless an accommodation is granted.
Requirements
- High school diploma or equivalent.
- Minimum of 2 years of claims processing and customer service experience.
- Minimum of 2 years of COB experience that required using NAIC & CMS COB guidelines.
- Ability to multi-task.
- Strong verbal and written communication skills.
- Attentive to details.
- Critical thinker.
- Problem-solver.
- Demonstrates empathy and persistence to resolve caller issues completely.
- Comfort and proficiency with digital tools and platforms.
Nice To Haves
- Federal/State newborn benefits experience preferred.
Responsibilities
- Utilizes internal queries and resource tools to identify members who are or should be enrolled in other coverage.
- Initiates delicate phone calls to other carriers, members, groups, providers, attorneys, CMS, and Medicaid.
- Aids members in enrolling in Medicare when they are entitled.
- Determines primacy on each case using a complex set of Primacy Rules mandated by State and Federal Laws (e.g., CMS Primacy, NAIC rules) and compares them against member/group benefits.
- Updates all company 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 to adjudicate impacted claims, using multiple COB Formulas for 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.
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs (unless covered by a collective bargaining agreement)
- Medical benefits
- Dental benefits
- Vision benefits
- Short and long term disability benefits
- 401(k) with match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
