Benefits Coordination Analyst: COB & Claims Analysis

Triple-S Management Corp.; San Juan (PR); On-site; USD 40,000 - 65,000; Full time

Job summary

Triple-S Management Corp. is seeking a detail-oriented COB claims analyst to support coordination of benefits across Medicare, Medicaid, and commercial lines. The role focuses on analyzing claims, identifying overpayments, and assembling documentation to support denials.

You will generate COB and medical claims reports, prepare defenses for Medicare Center responses, evaluate payments, and collaborate with Sales, Marketing, and Finance to ensure accurate, compliant processing.

Qualifications

• Bachelor’s Degree with 1–3 years in COB, claims evaluation or medical billing.
• Associate degree (60–64 credits) with 3–5 years in COB, claims evaluation or medical billing.
• None required for licenses/certifications.

Responsibilities

• Generate and analyze COB and medical claims data to identify overpayments.
• Prepare defense to response to Medicare Commercial Repayment Center.
• Evaluate Medicare payments related to Coordination of Benefits debts.
• Analyze pharmacy claims and internal overpayments.
• Create recovery COB adjustment petitions and reconcile data.
• Deliver Cost Avoidance reports with Sales and Marketing teams.
• Train other departments on COB end-to-end processes.
• Coordinate with CRC Supervisors on Demand Letters and liaise with Finance on CRC payments.
• Validate COB benefits in the QNXT enrollment module to ensure payment integrity.

Skills

COB analysis

Medical billing

Data analysis

Communication

Education

Bachelor's Degree

Associate's Degree

Tools

QNXT

Job description

Triple-S Management Corp. is seeking a detail-oriented COB claims analyst to support coordination of benefits across Medicare, Medicaid, and commercial lines. The role focuses on analyzing claims, identifying overpayments, and assembling documentation to support denials.

You will generate COB and medical claims reports, prepare defenses for Medicare Center responses, evaluate payments, and collaborate with Sales, Marketing, and Finance to ensure accurate, compliant processing.