Job Information
WellSense COB Specialist in United States
COB Specialist
WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, no matter their circumstances.
Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294368)
It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
Job Summary:
The Coordination of Benefits (COB) Specialist is responsible for optimizing COB recovery efforts by identifying and investigating health plan members for other insurance coverage. The COB Specialist is responsible for partnering with our providers and members to respond to and resolve incoming COB inquiries and appeals. The Specialist is expected to take complete responsibility for every interaction with a provider and a member by providing outstanding service. The Specialist is also responsible for accurate and timely processing of COB claims, completing activity reports, communicating COB policies to internal and external sources, and supporting the recovery efforts of the department.
Our Investment in You:
Full-time remote work
Competitive salaries
Excellent benefits
Key Functions/Responsibilities:
Responds to provider and member phone calls and correspondence including but not limited to claim adjustments requests, appeals, corrected claims, timely filings and projects
Investigates members for other insurance through phone calls, questionnaires, provider inquiries and claims in order to optimize savings to the Plan
Accurately processes COB claims in Facets, including retractions, denials, repayments and secondary balances
Processes all departmental reports in an accurate and timely manner and reports findings to the team lead and manager
Participates in departmental meetings and assists in the development of workflow and process improvements
Assists in internal departmental training programs on COB and participates in the training of new COB team members
Identifies additional methods for increased recoveries through interactions with internal and external customers
Qualifications:
Education:
- Bachelor’s Degree in Business, Healthcare Administration or related fields; or an equivalent combination of education, training, and experience is required
Experience:
Four or more years of progressively responsible experience in a healthcare or managed care field required
Experience in COB claims processing, and experience in a Medicaid MCO setting highly preferred
Competencies, Skills, and Attributes:
Proficient PC skills including all Microsoft Office products required
Candidate must be able to multi-task and prioritize work
Must have excellent verbal and written communication skills, organizational skills and customer service skills
The COB Specialist must demonstrate initiative for process improvement and have the ability to provide direction and feedback to co-workers
Ability to work both as a team member and independently
Working Conditions and Physical Effort:
- Ability to work OT during peak periods
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.WellSense is committed to the diversity and inclusion of staff and their members.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees
Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294368)
Important info on employment offer scams:
According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not reach out to individuals via text, we do not ask or require downloads of any applications, or “apps”, and applicant screenings, interviews and job offers are not conducted over text messages or social media platforms. We do not ask individuals to purchase equipment for, or prior to employment. To avoid becoming a victim of an employment offer scam, please followthese tips from the FTC (https://consumer.ftc.gov/consumer-alerts/2023/01/looking-job-scammers-might-be-looking-you?utm_source=govdelivery) .