Job Description

Job Title: COB Verification Processor
Job ID: 696046
Status: Full-Time
Regular/Temporary: Regular
Hours: 10 a.m. to 6 p.m.
Shift: Day Job
Facility: UPMC Health Plan
Department: GOVT ENROLLMENT
Location: 600 Grant St, Pittsburgh PA 15219

Description

Are you highly analytical with a strong customer service background? If so, an opportunity as a COB Verification Processor with UPMC Health Plan's Coordination of Benefits team may be the perfect fit for you!

The COB Verification Processor is responsible for investigation, documentation and verification of possible other insurance information for members. This position verifies possible instances of other insurance through internal and external data sources, as well as outbound calls to the other insurer and/or member to accurately determine the proper order of benefits based on state and federal guidelines while documenting and maintaining COB data in source system. The ideal candidate completes all duties with strict regard to policies and procedures set forth by Enrollment Services Manager, Centers for Medicare and Medicaid Services (CMS), Pennsylvania Department of Welfare (DPW), and Pennsylvania Insurance Department (PID). The COB Verification Processor is responsible for responding to internal customer inquiries and resolving issues to meet or exceed customer requirements. This position will work 10:00 a.m. to 6:00 p.m. Monday through Friday with weekends and occasional overtime as needed.

Responsibilities:
  • Ability to interpret and apply complex regulations as mandated by CMS, DPW, and PID as related to coordination of benefits and Medicare.
  • Daily clerical responsibilities related to processing and electronic storage of COB data.
  • Ensure proper scanning and documentation of COB surveys and Custody Court Order requests.
  • Identifies and communicates trends or areas of opportunity for process improvement to leadership in a proactive and efficient manner.
  • Identifies updates required to external systems, state or federal, and takes action to ensure the appropriate and accurate update is made in a timely manner.
  • Investigates all possible instances of other insurance appropriately utilizing internal and external systems to verify existence of other insurance.
  • Maintain employee/insured confidentiality.
  • Process all COB inquiries and instances in accordance with company policies and procedures in a timely manner while meeting production and quality goals.
  • Properly updates member record to reflect primary or secondary coverage based on findings. Ensures documentation is accurate, clear, and thorough.
  • Provides excellent customer service to members, as well as internal and external customers.
  • Support team projects within Enrollment Services; other projects as assigned.

Qualifications

  • High school graduate or equivalent required, college degree preferred.
  • Minimum of 1 year of customer service and/or call center experience.
  • Ability to interpret and apply COB regulations as mandated by CMS, DPW, PID, and the NAIC.
  • Demonstrates good organizational, interpersonal, leadership and communication skills.
  • Attention to detail is critical to the success of this position, with skills in customer orientation.
  • Will need to manage multiple tasks and projects.
  • MS Office/PC skills required.
  • Previous experience in an analysis based role preferred.

    Licensure, Certifications, and Clearances:
    UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $15.71 to $22.86

Union Position: No

Apply Current Employee?

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

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DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

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