Coordination of Benefits Specialist

Overview

Tenavi Staffing is seeking a detail-oriented Coordination of Benefits Specialist I to support healthcare payer operations and ensure accurate member eligibility and claims coordination. This role plays a critical part in maintaining the integrity of Other Health Insurance (OHI) and Coordination of Benefits (COB) data across membership and claims systems. The ideal candidate brings strong experience working with Medicare eligibility, CMS files, claims research, and payer sequencing in a regulated healthcare environment.

This position directly supports financial accuracy, claims processing efficiency, regulatory compliance, and member experience outcomes.

Location:

Doral, FL

Employment Type:

Full-Time
Pay Rate: $19.00–$21.00/hour
Industry: Healthcare

• Research and validate other insurance coverage using CMS eligibility files, payer databases, and internal systems
• Maintain accurate COB and eligibility records to support correct claims adjudication and payer sequencing
• Analyze claims history to identify coordination issues, over payments, and incorrect primary payer assignments
• Apply Medicare Secondary Payer (MSP) rules and CMS guidelines to determine accurate liability and coverage responsibility
• Reconcile eligibility, membership, and claims data across multiple systems to ensure data integrity
• Conduct outbound outreach to members, providers, employers, carriers, and government agencies to verify insurance coverage
• Update membership systems with verified COB findings and corrected coverage indicators
• Identify and resolve discrepancies tied to CMS enrollment data and eligibility records
• Support claims reprocessing, adjustments, and recovery efforts related to COB inaccuracies
• Document investigations, findings, outreach activity, and system updates in accordance with compliance and audit standards

• High School Diploma or GED required
• 3–5+ years of experience in healthcare claims, eligibility, Coordination of Benefits, or Medicare operations
• Strong understanding of Medicare Secondary Payer (MSP) rules and COB principles
• Experience working with CMS eligibility files, Medicare Advantage plans, or managed care organizations
• Ability to analyze claims data and determine correct payer responsibility
• Strong attention to detail with accurate documentation and data entry skills
• Experience navigating healthcare membership, claims, or eligibility systems
• Ability to manage multiple cases independently in a fast-paced environment

• Experience supporting Medicare Advantage or managed care health plans
• Knowledge of COB recovery and claims adjustment workflows
• Familiarity with CMS enrollment data and Medicare eligibility verification processes
• Experience working in regulated healthcare or payer environments
• Associate’s or bachelor’s degree in healthcare administration, Business, or related field preferred

• CMS eligibility and enrollment files
• Healthcare claims adjudication systems
• Membership and eligibility platforms
• Medicare Advantage systems
• COB and MSP workflows
• Microsoft Office Suite, including Excel
• Internal payer databases and external carrier verification tools

• Accurate and timely resolution of COB investigations and eligibility discrepancies
• Improved claims adjudication accuracy and reduction in payer sequencing errors
• Consistent compliance with CMS, MSP, and HIPAA requirements
• Strong documentation quality and audit readiness across all investigations
• Effective collaboration with claims, eligibility, and recovery teams to resolve coordination issues

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• The noise level in the work environment is usually moderate.
• Works in the field
• Interacts with patients, family members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances.

This work requires the following physical activities: climbing, bending,…