COB Representative

Site:
Mass General Brigham Health Plan Holding Company, Inc.

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.

We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.

The role is responsible for investigating potential recoveries for Coordinaton of Benefits through phone calls, questionnaires, claims, provider inquiries, and other systems as required. This incumbent will also be responsible for the management of communications with internal and external customers and a high level of research work related to the Coordination of Benefits opportunities. Deals directly with providers, members, CMS, and other health plans in the state and nationally regarding laws and statutes governing Coordinaton of Benefits.

• Responsible for identifying recovery opportunities within the Department.
• Review, research, and process all COB claims for members with other insurance, including retractions and repayments, according to desktop procedures, contractual requirements, and other regulatory rules.
• Responsible for reprocessing claims for COB termed members and ensuring information is added and maintained accurately in QNXT.
• Responsible for reviewing, researching, and resolving email inquiries from internal customers regarding members' claims and/or eligibility updates.
• Responsible for reviewing, researching, and resolving Medicare Secondary Payer (MSP) cases according to Medicare guidelines and procedures. Actively communicate case status to the group and Sales Team when needed.
• Coordinate recoveries per federal regulations with other insurers for services unable to be recovered.
• Process Credit Balance claims, refund checks, and validate claims retractions.
• Process COB questionnaires to members and make determinations of primary insurance in accordance with federal and state mandates.

Education

• High School Diploma or Equivalent required

Experience

• At least 2-3 years of coordination of benefits or third-party liability or other healthcare-related experience required

Knowledge, Skills, and Abilities

• Strong customer service skills.
• Knowledge of medical terminology.
• Excellent communication skills.
• High organization skills.
• Great problem-solving skills.

• This is a remote role that can be done from most US states
• The schedule for this position is Monday through Friday, 8:30 AM to 5:00 PM EST
• Remote workdays require a stable, secure, quiet, and HIPAA-compliant workspace. This will be confirmed via Microsoft Teams video for all employees

Remote

399 Revolution Drive

40

Regular

Day (United States of America)

$22.22 - $31.71/Hourly

4

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications;

however, it does not encompass all elements contributing to your total compensation…