Coordination of Benefits Representative (43974)

Job description

Job DetailsJob Location: Smithfield, RI - Smithfield, RI 02917Position Type: Full TimeEducation Level: Bachelors DegreeTravel Percentage: OccasionalJob Shift: DaytimeJob Category: Professional / ExperiencedThis position is responsible for the overall Coordination of Benefits (COB) process within the Payment Integrity department. This includes ensuring that the member’s enrollment records accurately reflect their primary/secondary coverage, leading to correct claims payment. This position investigates and resolves via outbound calls to other insurers, and CMS, as well as vendor partners and providers about COB leads generated from internal and external sources while meeting or exceeding designated quality standards. Identifies areas of improvement and works closely with interdepartmental teams around system enhancements. Reports upon COB metrics, as assigned. The COB Representative must have a comprehensive understanding of various regulations as related to COB and must complete all duties with strict regard to policies and procedures. Duties and Responsibilities: Responsibilities include, but are not limited to the following: Act as COB Operations Subject Matter Expert (SME) in the...