COB Representative

Mass General Brigham; Somerville (MA); Remote; USD 10,000 - 60,000; Full time

Job summary

A leading healthcare organization is seeking a professional for a Coordination of Benefits role, responsible for investigating recovery opportunities and managing communications with internal and external customers. The position requires strong customer service skills, good knowledge of medical terminology, and a high school diploma. The role is remote, allowing flexibility from various US states. Hourly pay ranges from $21.78 to $31.08, and a commitment to diversity and equity is core to the organization's values.

Qualifications

• 2-3 years of coordination of benefits or healthcare-related experience required.

Responsibilities

• Identify recovery opportunities within the Department.
• Review and process all COB claims for members with other insurance.
• Reprocess claims for COB termed members.
• Resolve email inquiries from internal customers regarding claims.
• Review and resolve Medicare Secondary Payer cases.
• Coordinate recoveries per federal regulations.
• Process Credit Balance claims and validate claims retractions.
• Make determinations of primary insurance based on COB questionnaires.

Skills

Strong customer service skills

Knowledge of medical terminology

Excellent communication skills

High organization skills

Great problem-solving skills

Education

High School Diploma or Equivalent

Job description

Overview

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

The role is responsible for investigating potential recoveries for Coordinaton of Benefits through phone calls, questionnaires, claims, provider inquiries, and other systems as required. This incumbent will also be responsible for the management of communications with internal and external customers and a high level of research work related to the Coordination of Benefits opportunities. Deals directly with providers, members, CMS, and other health plans in the state and nationally regarding laws and statutes governing Coordinaton of Benefits.

Responsibilities

• Responsible for identifying recovery opportunities within the Department.
• Review, research, and process all COB claims for members with other insurance, including retractions and repayments, according to desktop procedures, contractual requirements, and other regulatory rules.
• Responsible for reprocessing claims for COB termed members and ensuring information is added and maintained accurately in QNXT.
• Responsible for reviewing, researching, and resolving email inquiries from internal customers regarding member’s claims and/or eligibility updates.
• Responsible for reviewing, researching, and resolving Medicare Secondary Payer (MSP) cases according to Medicare guidelines and procedures. Actively communicate case status to the group and Sales Team when needed.
• 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 make determinations of primary insurance in accordance with federal and state mandates.

Qualifications

Education

• High School Diploma or Equivalent required

Experience

• At least 2-3 years of coordination of benefits or third-party liability or other healthcare-related experience required

Knowledge, Skills, and Abilities

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

Additional Job Details

Working Conditions

• This is a remote role that can be done from most US states

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$21.78 - $31.08/Hourly

Grade

4

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement

Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.