Job Title: Coordination of Benefits Processor

Department: Claims Processing

Reports To: Claims Processing Manager

Job Overview: The Coordination of Benefits Processor is responsible for investigating and updating of coordination of benefits for members with other health insurance. This role requires a detailed understanding of insurance policies, coverage, and the rules of coordination of benefits to ensure accurate and timely update of members coordination of benefits records.

Responsibilities and Duties:

• Review claims and other information received involving coordination of benefits.
• Determine the primary and secondary payers according to established rules and policies.
• Communicate with insurance carriers to resolve disputes and obtain necessary information.
• Maintain up-to-date knowledge of insurance regulations and policies related to coordination of benefits.
• Work closely with the claims processing team to ensure accurate claim adjudication.
• Provide customer service to policyholders regarding coordination of benefits inquiries.
• Utilize CMS and other vendor portals and databases to obtain other insurance coverage details.
• Collaborate with healthcare providers and insurers to obtain necessary documentation and information.
• Participate in training sessions to improve knowledge and performance.

Qualifications:

• High school diploma or equivalent; some college preferred.
• Experience in healthcare claims processing, specifically with coordination of benefits.
• Strong understanding of insurance policies and coverage.
• Excellent communication and customer service skills.
• Proficient in using healthcare claims software and Microsoft Office Suite.
• Ability to work independently and as part of a team.
• Detail-oriented with strong analytical and problem-solving skills.

Physical Requirements:

• Ability to work in an office environment when required
• Prolonged periods of sitting at a desk and working on a computer.