COB Claims Examiner & MSP Rules Expert

Blue Cross of Idaho; Meridian (ID); On-site; USD 40,000 - 57,000; Full time

Benefits offered by this job

Paid time off

Paid holidays

401(k) matching

Employee assistance plan (EAP)

Education reimbursement

Job summary

Blue Cross of Idaho is seeking a COB Claim Examiner to determine COB and potential claim overpayments for members with multiple coverages. You will review claims, apply MSP rules, and decide on pay/deny outcomes within policy guidelines.

Responsibilities include verifying eligibility, coordinating with internal teams, and supporting recovery of overpayments while maintaining quality standards. A 1-year relevant experience is preferred.

Qualifications

• Knowledge of Medicare Secondary Payer (MSP) rules and Other Health Insurance (OHI) processing.
• Familiarity with medical terminology and claims terminology.
• Strong verbal and written communication skills.

Responsibilities

• Review and analyze claims to determine proper COB and payer responsibility.
• Apply MSP rules, MSP guidelines and OHI determinations.
• Identify whether Medicare is primary or secondary based on MSP scenarios.
• Evaluate and validate OHI information for accurate processing.
• Request and verify eligibility and coverage information with members and providers.
• Collaborate with internal teams to resolve claims issues.
• Assist with recovery and adjustment when COB determinations cause overpayments.
• Process claims within productivity and quality standards.

Skills

MSP rules knowledge

Medical terminology

Verbal & Written communication

Job description

Blue Cross of Idaho is seeking a COB Claim Examiner to determine COB and potential claim overpayments for members with multiple coverages. You will review claims, apply MSP rules, and decide on pay/deny outcomes within policy guidelines.

Responsibilities include verifying eligibility, coordinating with internal teams, and supporting recovery of overpayments while maintaining quality standards. A 1-year relevant experience is preferred.