COB Recovery Specialist – Remote

Mass General Brigham Health Plan, Inc.; Somerville (MA); Remote; USD 30,000 - 44,000; Full time

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking a COB Specialist to investigate potential recoveries for Coordination of Benefits through phone calls, questionnaires, claims, provider inquiries, and other systems.

The incumbent will also manage communications with internal and external customers and conduct extensive research related to COB opportunities. The role involves dealing with providers, members, CMS, and other health plans in the state and nationally, following

Qualifications

• Strong customer service skills.
• Knowledge of medical terminology.
• Excellent communication skills.
• High organization skills.
• Great problem-solving skills.

Responsibilities

• Identify recovery opportunities within the Department.
• Review, research, and process COB claims for members with other insurance.
• Reprocess claims for COB termed members and ensure information is updated in QNXT.
• Review, research, and resolve email inquiries from internal customers regarding members' claims and/or eligibility updates.
• Review, research, and resolve MSP cases according to Medicare guidelines; communicate status.
• Coordinate recoveries per federal regulations with other insurers for services unable to be recovered.
• Process Credit Balance claims, refund checks, and validate claims retractions.
• Process COB questionnaires to members and determine primary insurance per mandates.

Skills

Customer service

Medical terminology

Communication skills

Organization

Problem-solving

Education

High School Diploma or Equivalent

Job description

Mass General Brigham Health Plan Holding Company, Inc. is seeking a COB Specialist to investigate potential recoveries for Coordination of Benefits through phone calls, questionnaires, claims, provider inquiries, and other systems.

The incumbent will also manage communications with internal and external customers and conduct extensive research related to COB opportunities. The role involves dealing with providers, members, CMS, and other health plans in the state and nationally, following