Coordination of Benefits Processor (Managed Care) Remote

Molina Healthcare; Long Beach (CA); Remote; USD 52,000 - 68,000; Full time

Job summary

Molina Healthcare is hiring for a Coordination of Benefits Processor. This remote role supports multiple lines of business, including Medicare and Marketplace, with a preference for candidates in the PST time zone.

The role requires at least 1 year of administrative healthcare experience, strong MS Office skills, and excellent attention to detail. You will validate coverage, review EOBs, update COB data, and assist the COB team with data entry and customer service.

Qualifications

• Minimum 1 year of administrative support experience or equivalent
• Customer service skills
• Strong attention to detail, organizational and time-management abilities
• Ability to collaborate across a matrixed organization and maintain relationships with stakeholders
• Effective verbal and written communication skills
• Proficiency with Microsoft Office and applicable software

Responsibilities

• Supports multiple Lines of Business (LOBs), including Medicare and Marketplace (MKP)
• Validates external medical and pharmacy coverage through provider portals, outbound calls, and review of Explanation of Benefits (EOBs) to identify and verify other insurance information
• Researches and validates COB leads through insurer outreach and online resources
• Reviews and interprets EOBs, medical claims, and eligibility information to determine COB actions
• Processes provider disputes and submits claim adjustments to ensure correct payments based on COB information
• Maintains internal databases and other insurance records for accurate member coverage
• Submits CMS ECRS requests to update external coverage information in CMS system
• Maintains compliance with procedures and regulatory requirements related to COB and Medicare coordination
• Provides telephone and data entry support for the COB team
• Uses insurance portals to validate COB leads from state, vendor, and internal sources
• Updates the claims system COB table and COB tracking database
• Contacts CMS or logs tickets for premium restoration activities such as MSP and ESRD

Skills

Healthcare experience

Administrative healthcare experience

MS Office Suite

Attention to detail

Work history

Tools

MS Office Suite

Job description

Job Summary

Molina Healthcare is hiring for Coordination of Benefits Processor. This role is remote and can be worked from a variety of locations. PST Time Zone is preferred.

Highly Qualified Candidates Will Have the Following Experience

• Healthcare Experience
• Administrative healthcare experience
• Solid experience with the MS Office Suite
• High attention to detail
• Solid work history

Essential Job Duties

• Supports multiple Lines of Business (LOBs), including Medicare and Marketplace (MKP)
• Validates external medical and pharmacy coverage through provider portals, outbound calls, and review of Explanation of Benefits (EOBs) to identify and verify other insurance information.
• Researches and validates state, vendor, and internal Coordination of Benefits (COB) leads through insurance carrier outreach and online resources.
• Reviews and interprets EOBs, medical claims, and eligibility information to determine appropriate COB actions.
• Processes provider disputes and submits claim adjustments to ensure claims are paid correctly based on validated COB information.
• Maintains Internal databases and other insurance records to ensure accurate member coverage information.
• Submits ECRS requests to CMS to update external coverage information within the CMS system.
• Maintains compliance with departmental procedures, documentation standards, and regulatory requirements related to COB and Medicare coordination.
• Provides telephone, administrative and data entry support for the coordination of benefits (COB) team.
• Phones or utilizes other insurance company portals to validate state, vendor and internal COB leads.
• Updates the other insurance table on the claims transactional system and COB tracking database.
• Contacts Centers for Medicare and Medicaid Services (CMS) directly, or coordinates with the assigned company contact to log tickets for premium restoration such as Medicare Secondary Payer (MSP) and End-Stage Renal Disease (ESRD).

Job Requirements

• At least 1 year of administrative support experience, or equivalent combination of relevant education and experience.
• Customer service skills.
• Attention to detail, organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
• Ability to work cross-collaboratively across a highly matrixed organization and establish and maintain effective relationships with internal and external stakeholders.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

• Health care experience.

Benefits and Compensation

• Molina Healthcare offers a competitive benefits and compensation package.

Equal Opportunity Statement

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V