Role Description Are you experienced in Coordination of Benefits (COB), Medicare, insurance verification, healthcare claims, or medical billing? We're looking for a detail-oriented healthcare professional who enjoys solving complex insurance coverage issues and working in a fast-paced remote environment. As a Coordination of Benefits (COB) Specialist, you'll: - Investigate insurance coverage and determine the correct order of benefits. - Communicate with insurance carriers and healthcare providers. - Ensure claims are processed accurately while remaining compliant with Medicare and federal regulations. Key Responsibilities - Investigate and determine the correct Coordination of Benefits (COB) for members with multiple health insurance plans. - Review insurance eligibility, policy coverage, and documentation to verify the proper payer order. - Contact insurance carriers, Medicare (CMS), employer groups, healthcare providers, and members by phone, email, fax, and mail to validate coverage information. - Research complex healthcare eligibility issues and apply Medicare CMS and NAIC guidelines to determine primary and secondary coverage. - Document findings accurately in company systems while maintaining complete and detailed records. - Review Explanation of Benefits (EOBs) and other insurance documentation to support payment determinations. - Process incoming COB correspondence and update eligibility records as needed. - Handle inbound and outbound calls related to Coordination of Benefits inquiries. - Meet established productivity, quality, and turnaround time goals. - Maintain HIPAA compliance and adhere to all federal, state, and client requirements. - Collaborate with teammates while working independently in a remote environment. - Identify opportunities to improve processes, documentation, and communication. Qualifications - Minimum of 2 years of healthcare experience involving Coordination of Benefits (COB) in a provider, payer, or healthcare vendor environment OR 4+ years of experience in one or more of the following: - Insurance Verification - Medical Billing - Healthcare Claims Processing - Claims Auditing - Medical Reimbursement - Healthcare Data Analysis - Working knowledge of Coordination of Benefits (COB) guidelines. - Knowledge of Medicare (CMS) regulations and NAIC Coordination of Benefits guidelines. - Understanding of medical terminology and healthcare eligibility processes. - Strong investigative, research, and critical thinking skills. - Excellent verbal and written communication skills. - Ability to explain complex insurance information clearly and professionally. - Strong customer service skills with the ability to communicate confidently with insurance carriers, providers, employer groups, and members. - Experience working in a production-driven environment while maintaining high-quality standards. - Strong organizational and multitasking abilities. - Proficiency with Microsoft Office (Word, Excel, and Outlook). - Ability to work independently while collaborating effectively with a remote team. Benefits - Fully remote position - Flexible Monday-Friday schedule - No weekends required - Competitive starting pay - Collaborative team environment - Eligible for benefits day 1