Strategic Benefits & COB Recovery Analyst

EmblemHealth; New York (NY); On-site; USD 56,000 - 99,000; Full time

Job summary

EmblemHealth is seeking a Benefits Coordination and Recovery Specialist to research payer order, identify primary/secondary payers, and recover COB-related overpayments. The role requires strong analytical skills and meticulous documentation within Facets, QNXT, and CMS processes.

You will collaborate with members, carriers, and CMS to resolve complex eligibility and COB issues, ensuring compliant claims adjudication and timely data updates across systems.

Qualifications

• Bachelor’s degree required; related field considered.
• 3–5+ years in health insurance claims, COB, or payment integrity.
• Knowledge of COB rules and overpayment recovery.
• Experience with Facets or QNXT preferred.
• Strong written and verbal communication.

Responsibilities

• Investigate and determine COB payer order for Commercial, Medicare, and Medicaid lines.
• Update claims systems with COB flags and policy terms to ensure accurate future processing.
• Identify, calculate, and recover COB-related overpayments.
• Coordinate with BCRC, CWF, and CMS for status updates and reconciliations.
• Maintain documentation of investigations and recovery activities in company databases.
• Communicate with members, providers, and insurers to verify coverage and resolve inquiries.
• Ensure compliance with COB regulations and CMS requirements.

Skills

Analytical skills

Communication skills

Detail-oriented

Problem-solving

Team collaboration

MS Office proficiency

Education

Bachelor’s degree in healthcare administration or related field

Tools

Facets

QNXT

CMS portals

Job description

EmblemHealth is seeking a Benefits Coordination and Recovery Specialist to research payer order, identify primary/secondary payers, and recover COB-related overpayments. The role requires strong analytical skills and meticulous documentation within Facets, QNXT, and CMS processes.

You will collaborate with members, carriers, and CMS to resolve complex eligibility and COB issues, ensuring compliant claims adjudication and timely data updates across systems.