Medicare COB Claims Examiner (MSP/OHI Expert)

Blue Cross of Idaho; Meridian (AR); On-site; USD 26,000 - 37,000; Full time

Benefits offered by this job

Paid time off

Paid holidays

Health insurance

401(k) matching

Life insurance

Short and long-term disability

Job summary

Blue Cross of Idaho is seeking a COB Claim Examiner to determine coordination of benefits and potential claim overpayments for members with multiple coverages. You will review claims and apply COB rules to decide whether to pay, deny, or adjust payments.

The role requires about 1 year of relevant experience and familiarity with MSP and OHI guidelines. You will collaborate with internal teams, verify eligibility, and ensure accurate processing within productivity and quality standards.

Qualifications

• 1 year of relevant claims experience is required.
• Familiarity with Medicare Secondary Payer rules and MSP guidelines preferred.
• Ability to follow detailed policies and regulatory requirements.

Responsibilities

• Review and analyze claims to determine COB and payer responsibilities.
• Apply MSP and OHI rules to determine primary vs. secondary payment.
• Identify MSP scenarios (working aged, ESRD, disability, liability, workers' comp).
• Verify eligibility and coverage information from members and providers.
• Collaborate with internal teams to resolve COB issues.
• Assist with recovery and adjustment of overpayments.
• Process claims accurately within productivity and quality standards.

Skills

MSP rules knowledge

OHI processing

Medical terminology

Policy adherence

Verbal & written communication

Tools

Claims systems

Job description

Blue Cross of Idaho is seeking a COB Claim Examiner to determine coordination of benefits and potential claim overpayments for members with multiple coverages. You will review claims and apply COB rules to decide whether to pay, deny, or adjust payments.

The role requires about 1 year of relevant experience and familiarity with MSP and OHI guidelines. You will collaborate with internal teams, verify eligibility, and ensure accurate processing within productivity and quality standards.