Product Manager, Coordination of Benefits

Navitus Health Solutions, LLC

90d • $82,586 - $101,333

About The Position

Navitus Health Solutions is seeking a Coordination of Benefits Product Manager to join our team! The Product Manager, Coordination of Benefits is responsible for the development, administration, maintenance, and oversight of the COB Program. The Product Manager will ensure that the appropriate software, processes, procedures, and oversight monitoring are implemented and operational to meet changing COB program needs. The Product Manager, Coordination of Benefits will work closely with members of the following departments: Analytics, Benefit Systems, Claims Adjudication Development, Client Services, Compliance, Data Services, Government Programs, Implementation, and Member Service, ensuring COB is administered and maintained according to industry, state, federal, Medicare, Medicaid, and Exchange regulations.

Requirements

• College degree or equivalent experience required in managed care or health insurance.
• Minimum of five years’ experience with Medicare, Medicaid and Commercial claims processing, COB and third-party recoveries in an automated claims environment required.
• Minimum of five years’ experience managing a product or program in the managed care or healthcare industry.
• Pharmacy claims processing experience highly desirable; or equivalent combination of health insurance and/or managed care claims processing which would provide the required knowledge, skills, and abilities.
• Knowledge of National Association of Insurance Commissioners (NAIC), healthcare industry practices, HIPAA, and applicable data privacy practices required.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

Responsibilities

• Manages coordination of benefits (COB) day-to-day work: Coordinates and monitors third party liability (TPL), other health insurance (OHI) files process and loads.
• Ensures accurate and timely reporting.
• Ensures turnaround times and performance guarantees are met.
• As needed, initiates calls to other insurance carriers/pharmacies to gather coordination of benefits data and pursue COB recoveries (pay and chase).
• Serves as the subject matter expert for COB program questions, COB system enhancements and build, COB RFP questions and new client implementations involving COB.
• Remains current with changing regulatory and industry COB requirements, ensuring the Navitus COB program remains compliant.
• Leads and participates in applicable NCPDP COB task groups.
• Meets with key personnel in other departments to understand COB needs, makes recommendations and leads the implementations of solutions to meet customer and program needs.
• Regularly audits and tests COB operational processes to ensure end to end integrity.
• Creates and maintains COB policies, procedures, workflow, and training.
• Other duties as assigned.

Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance.
• 20 days paid time off.
• 4 weeks paid parental leave.
• 9 paid holidays.
• 401K company match of up to 5% - No vesting requirement.
• Adoption Assistance Program.
• Flexible Spending Account.

What This Job Offers

• Job Type: Full-time
• Education Level: Bachelor's degree
• Number of Employees: 501-1,000 employees