Job Description

Job Title: COB Specialist
Job ID: 756479
Status: Full-Time
Regular/Temporary: Regular
Hours: Daylight
Shift: Day Job
Facility: UPMC Health Plan
Department: GOVT ENROLLMENT
Location: 300 State St, Erie PA 16507

Description

Responsible for investigation, documentation and processing of multiple types of other insurance claims while meeting or exceeding designated production and quality standards. Conducts outbound calls to insurers to verify other coverage information provided to us by the member, CMS, or other entities. Document and maintain COB data in source system.


To successfully perform the role, the COB Specialist must have a comprehensive understanding of various regulations as related to COB and subrogation, and must complete all duties with strict regard to policies and procedures. 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). Responsible for responding to internal customer inquiries and resolving issues to meet or exceed customer requirements. In addition, the Coordination of Benefits Specialist I should maintain a high level of interaction with the other internal departments.

Responsibilities:

  • Ability to interpret and apply complex regulations as mandated by CMS, DPW, and PID as related to coordination of benefits, subrogation, and Medicare.
  • Accurately recognizes and reports trends or issues identified from daily work and works in partnership with leadership to develop and implement solutions. Consistently meets departmental production standards Consistently meets departmental quality standards
  • Demonstrates strong knowledge of claims processing, ensures claims and associated holds impacted by other insurance are properly researched and resolved in a timely fashion. Recognizes and takes action to ensure timely reprocessing of claim(s).
  • 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. Reviews and works any submission rejection in a timely manner and consistently meets departmental goals related to submission acceptance.
  • Identify areas of opportunity to improve service to members and/or reduce member impact. Initiate outreach efforts, to members, other carriers, or clients, when deemed appropriate or necessary to gather necessary information to resolve issues or appropriate resolve case..
  • Interface with internal and external customers to assure resolution of inquiries and concerns. Access, investigate, and resolve issues to achieve customer satisfaction, seeking to achieve one touch resolution with all departmental requests for assistance. .
  • Investigates all possible instances of other insurance for all lines of business appropriately and accurately utilizing internal and external systems to verify existence of other insurance. Appropriately and accurately applies NAIC, Medicare, and other state and/or federal regulations to determine proper order of benefits.
  • Processes member requests to update other insurance coverage, including from surveys, phone calls, custody court order requests, or other member correspondence. Ensures request is fully processed, documented, and resolved.
  • Properly updates member record to reflect primary or secondary coverage based on findings. Ensures documentation is accurate, clear, and thorough.
  • Provides support with departmental mailboxes, web requests, and/or chats. Consistently demonstrates courteousness and professionalism with internal and external customers. Anticipates and addresses additional questions and concerns.

Qualifications

  • High school diploma or equivalent required; college degree preferred.
  • One (1) year of customer service experience and or other business environment.
  • Ability to interpret and apply complex regulations as mandated by CMS, DPW, and PID as related to coordination of benefits, subrogation, and Medicare.
  • Strong 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.
  • Strong analytical skills required.
  • MS Office/PC skills required.
  • One to two (1-2) years claims adjustment experience highly preferred

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

Salary Range: $12.95 to $19.71 / hour

Union Position: No

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