ECOB Specialist II

Overview

Location
:
This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Please note that per our policy on hybrid/virtual/ work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law

Hours
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Monday - Friday from 8:00 am - 4:30 pm EST.

eCOB Specialist II is responsible for researching and investigating other coverage for all of the company s groups and members on multiple platforms. Fully proficient in all key areas; performs multi complex functions and interprets complex rules, laws and contracts. Accountable for end-to-end functionality on every Coordination of Benefits (COB) function including reconciliation of claim, membership and accounting.

• Utilizes internal queries, internal resource tools, and initiates delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS and Medicaid; reports to identify members who are or should be enrolled in other coverage.
• Aides members in enrolling in Medicare when they are entitled.
• Determines primacy on each case using a complex set of Primacy Rules as mandated by State and Federal Laws, such as CMS Primacy and NAIC rules, and comparing them against the member/groups 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.
• Identify the correct formulas to adjudicate impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines.
• Handle multi-tasking including calls, texts, facsimiles, and electronic queues, while taking notes and speaking to customers.
• Demonstrates proficiency in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced environment; strong verbal and written communication skills; attention to detail; critical thinking and problem-solving; empathy and persistence to resolve caller issues; comfort with digital tools and platforms to enhance productivity.
• Structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.
• Performs other duties as assigned.

• HS diploma or equivalent and a minimum of 2 years of claims processing and customer service and 2 years COB experience that required using NAIC & CMS COB guidelines; or any combination of education and experience which would provide an equivalent experience.

• Medicare and CAQH knowledge preferred

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If…