Payment Integrity Analyst- COB

TBC Corporation

About The Position

Lyric is an AI-first, platform-based healthcare technology company focused on simplifying healthcare by preventing inaccurate payments and reducing waste, thereby lowering the cost of care for payers, providers, and patients. With 35 years of pre-pay editing expertise, Lyric is recognized as a market leader and has received accolades such as 2025 Best in KLAS for Pre-Payment Accuracy and Integrity, HI-TRUST and SOC2 certifications, and the 2025 CandE Award for Candidate Experience. The company is committed to innovation with AI in healthcare. The Payment Integrity Analyst (COB) role supports the Coordination of Benefits (COB) program. This involves 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. The position requires 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 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

Nice To Haves

Bachelors degree in business or healthcare/related field
Strong written and verbal communication skills.
Excellent documentation accuracy and attention to detail.
Ability to work within established productivity and quality metrics.
Comfortable navigating multiple systems, portals, and payer interfaces.
Strong problem-solving skills with the ability to reconcile conflicting or incomplete information.
Ability to maintain confidentiality and comply with HIPAA and data security standards.
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

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.
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.
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.
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.