eCOB Specialist II - Newborn Members

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 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 is a virtual role with the exception of required in-person training sessions, offering flexibility and autonomy. 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, 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.
Structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.

Nice To Haves

Federal/State newborn benefits experience preferred.

Responsibilities

Utilizes internal queries and resource tools to initiate phone calls to other carriers, members, groups, providers, attorneys, CMS, and Medicaid to identify members who are or should be enrolled in other coverage.
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 and NAIC rules) and compares them against member/group 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 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 simultaneously while taking notes and speaking to customers.
Performs other duties as assigned.