Payment Integrity Analyst - Coordination of Benefits

TBC Corporation

17d•$24 - $35

About The Position

Lyric is an AI-first, platform-based healthcare technology company, committed to simplifying the business of care by preventing inaccurate payments and reducing overall waste in the healthcare ecosystem, enabling more efficient use of resources to reduce the cost of care for payers, providers, and patients. Lyric, formerly ClaimsXten, is a market leader with 35 years of pre-pay editing expertise, dedicated teams, and top technology. Lyric is proud to be recognized as 2025 Best in KLAS for Pre-Payment Accuracy and Integrity and is HI-TRUST and SOC2 certified, and a recipient of the 2025 CandE Award for Candidate Experience. Interested in shaping the future of healthcare with AI? Explore opportunities at lyric.ai/careers and drive innovation with #YouToThePowerOfAI. Applicants must already be legally authorized to work in the U.S. Visa sponsorship/sponsorship assumption and other immigration support are not available for this position. The Payment Integrity Analyst (COB) supports the Coordination of Benefits (COB) program by investigating and validating other insurance coverage, resolving conflicting eligibility information, and establishing the correct order of liability (primary vs. secondary payer) to prevent and recover improper claim payments. This role performs hands-on casework in a high-volume environment including outreach, documentation, and system updates, while applying analytical skills to interpret claims and eligibility data, identify trends, and recommend process improvements that improve accuracy for the COB program.

Requirements

Bachelor’s Degree and/or one (1) year of related healthcare experience (e.g., COB/TPL, eligibility, claims operations, billing, recovery, or payment integrity).
Minimum of one (1) year of experience performing COB investigations and/or payment integrity casework, including independent ownership of moderate-to-complex inventories.
Minimum of one (1) year of experience performing data analytics with large data sets
Minimum of one (1) year of experience using working knowledge of coordination of benefits rules, primary/secondary payer logic, coverage hierarchy, and order-of-liability concepts; understanding of CMS and NAIC guidance as applicable..
Comfortable navigating multiple systems, portals, and payer interfaces.
Ability to maintain confidentiality and comply with HIPAA and data security standards.

Nice To Haves

Bachelors degree in business or healthcare/related field
Knowledge of claim adjudication workflows and payment rules.
Familiarity with eligibility data and outreach processes in the healthcare industry for coordination of benefits.
Experience with SQL
Experience within high-volume, SLA-driven operations teams.
Creative thinker with an entrepreneurial spirit

Responsibilities

Investigation and verification Review, prioritize, and work assigned COB leads (automated and manual) to determine required verification steps and next actions.
Investigate and validate coverage details (payer, plan type, subscriber relationship, policy indicators, effective/termination dates) using internal systems, payer portals, EOBs/claim responses, and other approved data sources.
Apply COB rules and guidelines, including CMS and NAIC guidance as applicable, to determine the correct order of liability and document the rationale for the primacy determination.
Outreach, documentation, and system updates Contact insurance carriers, employers, clearinghouses, providers, and other third parties as needed to confirm or clarify coverage information and obtain supporting evidence.
Create clear, detailed, and accurate case notes that capture verification steps, evidence, and outcomes in internal tools to support audits and downstream recovery/reprocessing.
Update eligibility/COB records and coordination rules based on verified information and confirm updates are applied correctly to reduce downstream adjudication errors and abrasion.
Payment integrity support & Operational excellence Provide validated COB outcomes that support downstream payment integrity activities (recovery, reprocessing, adjustments) with minimal rework.
Prepare and evaluate documentation needed for inquiries, disputes, and appeals related to determinations, as assigned.
Meet or exceed established productivity, turnaround time, and quality/audit standards while managing a high-volume case queue.
Analytical contribution Track outcomes and error categories, identify root causes of recurring COB issues and false positives, and recommend opportunities to streamline research, improve data quality, and reduce incorrect payments.
Use Excel and other tools to support ad hoc analysis (e.g., trend review, inventory quality checks, and performance insights); partner with stakeholders to clarify requirements and improve workflows.
Reconcile discrepancies across sources (eligibility feeds, member/group data, claim history, and third-party responses) and drive cases to a clear, audit-ready determination.