Coordination of Benefits Processor (Managed Care) Remote

UnitedHealth Group; United States; Remote; USD 28,000 - 41,000; Full time

Job summary

Molina Healthcare is hiring for a Coordination of Benefits Processor to support COB activities remotely across the United States. PST Time Zone is preferred for collaboration.

The role requires healthcare administrative experience, strong MS Office skills, high attention to detail, and the ability to manage multiple tasks in a matrixed organization.

Qualifications

• 1 year of administrative support experience or equivalent education/experience.
• Customer service skills required.
• Strong attention to detail and time-management.
• Ability to work cross-collaboratively in a matrixed organization.
• Excellent verbal and written communication skills.
• Proficiency with Microsoft Office and related 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 EOBs to verify other insurance information.
• Researches and validates state, vendor, and internal COB leads through insurance carrier 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 claims are paid correctly based on 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 COB team.
• Phones or utilizes insurance portals to validate COB leads.
• Updates the other insurance table on the claims system and COB tracking database.
• Contacts CMS directly or logs tickets for MSP and ESRD.

Skills

Healthcare experience

Administrative healthcare experience

High attention to detail

Solid work history

Customer service skills

Attention to detail

Tools

MS Office Suite

Job description

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.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Same Posting Description for Internal and External Candidates

Pay Range: $20.34 - $30.39 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.