Hybrid eCOB Specialist II — Claims & Coverage Expert

Anthem Blue Cross & Blue Shield; Columbus (GA); Hybrid; USD 60,000 - 80,000; Full time

Job summary

Elevance Health is seeking an eCOB Specialist II to manage complex coordination of benefits for multiple groups and members. You will perform end-to-end COB functions, including claim reconciliation, membership updates, and Medicaid interactions, leveraging NAIC and CMS guidelines.

You will communicate with members, providers, and carriers, determine primacy, and ensure proper enrollment forms are used for Medicare. A hybrid/virtual work model with occasional in-person training is available.

Qualifications

• Requires HS diploma or equivalent and at least 2 years in claims processing.
• At least 2 years COB experience using NAIC & CMS guidelines.
• Two years of customer service experience.

Responsibilities

• Utilizes internal queries and tools to identify members enrolled in other coverage.
• Aides members in enrolling in Medicare when entitled.
• Determines primacy using complex Primacy Rules per State and Federal laws.
• Updates membership systems with investigation results for claim coordination.
• Ensures correct forms are provided for Medicare enrollment.
• Reviews claim history to identify reconciliations and errors.
• Identifies correct formulas to adjudicate impacted claims per COB rules.
• Handles calls, texts, and electronic queues while taking notes and talking to customers.
• Maintains focus in a fast-paced environment and demonstrates empathy and problem solving.
• Work schedule with occasional overtime or office time based on business needs.

Skills

Claims processing

Customer service

COB knowledge

Education

HS diploma or equivalent

Job description

Elevance Health is seeking an eCOB Specialist II to manage complex coordination of benefits for multiple groups and members. You will perform end-to-end COB functions, including claim reconciliation, membership updates, and Medicaid interactions, leveraging NAIC and CMS guidelines.

You will communicate with members, providers, and carriers, determine primacy, and ensure proper enrollment forms are used for Medicare. A hybrid/virtual work model with occasional in-person training is available.