Claims COB Investigator

Responsibilities

• Investigate other insurance information to coordinate benefits for claims processing
• Direct contact with members, CMS, or other health plans via telephone, letters, email, or portal submissions to obtain/verify other insurance information
• Determine primacy based on the other insurance obtained and confirm automatic filing order (AFO) is accurate
• Update Health Link with the other insurance information and ensure AFO is accurate
• Reconcile COB Smart, Discovery Health Partners, and Department of Health Services, to make sure other insurance and primacy determination is accurate
• Responsible to resolve COB primacy disputes
• Research external inquiries/complaints from members, providers, vendors, other health plan, governmental entities, etc. for dispute resolution and send claims to be adjusted
• Process claims, pends, and reports, as assigned, in the claims processing system
• Obtain all information needed to adjudicate claims appropriately through internal and external verbal and written correspondence
• Identify trends and opportunities for process improvement, including changes needed to the Claims Manual

Qualifications

• A high school diploma or equivalency
• Three years of medical claims processing experience working in an office setting
• One year of claims processing experience at Quartz consistently meeting quality and quantity goals