Remote Coordination of Benefits Specialist

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

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.