COB & Benefits Claims Analyst — Healthcare Data Insight

Triple-S; Guaynabo (PR); Vor Ort; USD 55.000 - 75.000; Vollzeit

Zusammenfassung

Triple-S is seeking a COB/claims specialist to analyze benefits coordination claims when insured has coverage through other insurers. You will collect, present, and explain documentation supporting service denials and work to recover overpayments.

The role requires 1–5 years in COB, claims evaluation or medical billing, and a background in analyzing Medicare and related plans. Bachelor’s or Associate degrees are expected, with opportunities to train across departments.

Qualifikationen

• Bachelor's Degree with 1–3 years of related experience in COB, claims evaluation, or medical billing.
• Associate degree (60–64) college credits with 3–5 years of experience in COB, claims evaluation, or medical billing.

Aufgaben

• Generate and analyze COB and medical claims data to identify overpayments across Commercial, Medicare and Medicaid.
• Compile documents and prepare defense for Medicare Recovery Center responses.
• Evaluate Medicare payments related to COB debts.
• Analyze pharmacy reports and internal overpayments.
• Create COB adjustment petitions and reconcile data; deliver Cost Avoidance reports with Sales and Marketing teams.
• Review Plan Documents, COB Certification and Policies to resolve debts.
• Provide training to other departments on end-to-end COB processes.
• Coordinate with CRC Supervisors on Demand Letters and with Finance on demand checks.
• Validate COB payment integrity in the enrollment module (QNXT).

Kenntnisse

Ambiguity Management

Trust Building

Collaboration

Customer Focus

Action Oriented

Ausbildung

Bachelor's Degree

Associate's Degree

Jobbeschreibung

Triple-S is seeking a COB/claims specialist to analyze benefits coordination claims when insured has coverage through other insurers. You will collect, present, and explain documentation supporting service denials and work to recover overpayments.

The role requires 1–5 years in COB, claims evaluation or medical billing, and a background in analyzing Medicare and related plans. Bachelor’s or Associate degrees are expected, with opportunities to train across departments.