Coordination of Benefits Specialist

MISSION

Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

VALUES

HealthOne is guided by a cultural framework that embodies our values and drives our decisions.

Our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you're starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

JOB PURPOSE

The Coordination of Benefits Specialist investigates and addresses questions about multiple health plan coverages for members and dependents. The incumbent contacts members, providers, and other insurance companies to collect COB data, aiming to identify problems, assess their impact on clients, and find solutions.

ESSENTIAL JOB DUTIES

• Generates reports in various systems to monitor daily inventory.
• Identifies and applies appropriate conditions.
• Investigates, resolves, and responds to moderately complex and urgent inquiries using both internal and external systems.
• Reviews and approves payment orders for Client Services inquiries sent to the Payment Integrity department for investigation and file updates.
• Reviews and approves payment orders for claims sent to the Payment Integrity department for investigation and file updates.
• Updates member COB files based on returned correspondence and questionnaires.
• Attends departmental meetings and contributes to workflow and process improvements.
• Assesses the accuracy of EOPs and ensure that the information from primary insurers is valid and complete before proceeding with secondary claims processing.
• Follows up on delays or denials : addresses any claim delays, denials, or overpayments by following up with the correct areas to obtain the necessary information to move the claim forward.
• Prepares reports, and generates reports related to COB processing, such as claims data, payments, denials, and exceptions, as needed.
• Timely filing : ensures that claims refunds are completed within the timeframe required.
• Handles phone inquiries about COB from internal customers, including Client Services, Operations, and other insurance companies.
• Maintains regular and predictable attendance
• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
• Works to encourage and promote Company culture throughout the organization
• Other duties as may be assigned

QUALIFICATIONS

PHYSICAL REQUIREMENTS

Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime / overnight travel as required.

BENEFITS

401K (4% Match, Immediate Vesting)

Accident insurance

Competitive salary

Critical Illness Insurance

Dental Insurance

Employee Assistance Program

Flexible Spending Account

Health & Wellness Program

Health Savings Account

Life & AD&D Insurance

Long Term Disability

Medical Insurance

Paid Time Off

Pet Insurance

Short Term Disability

Vision Insurance

PRE-EMPLOYMENT SCREENING

Drug Screen and Background Check Required

HEALTHONE IS AN EQUAL OPPORTUNITY EMPLOYER

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.