COB Claims Examiner

About the role

We Are Looking For a Claim Examiner With Experience: 1-year relevant experience

Responsibilities

• Review and analyze claims to determine proper Coordination of Benefits (COB), including primary and secondary payer responsibility
• Apply Medicare COB rules, including Medicare Secondary Payer (MSP) guidelines and Other Health Insurance (OHI) determinations
• Determine whether to return, deny or pay claims following organizational policies and procedures
• Identify situations where Medicare is primary vs. secondary based on MSP provisions (e.g., working aged, ESRD, disability, liability, no-fault, and workers’ compensation cases)
• Evaluate and validate OHI information to ensure accurate claims processing and reimbursement
• Request and verify eligibility and coverage information from members, providers, and other insurance carriers
• Collaborate with internal teams (e.g., Payment Integrity, Recovery, Customer Service) to resolve claims issues
• Assist with recovery and adjustment of claims when incorrect COB determinations result in overpayment
• Process claims accurately within established productivity and quality standards

Requirements

• Basic knowledge of Medicare Secondary Payer (MSP) rules and Other Health Insurance (OHI) processing
• Knowledge of medical terminology
• Ability to complete assigned individual tasks within scope
• Ability to follow detailed policies, guidelines, and regulatory requirements
• Verbal & Written Communication

Qualifications

We Are Also Looking For Basic knowledge of Medicare Secondary Payer (MSP) rules and Other Health Insurance (OHI) processing
Knowledge of medical terminology
Ability to complete assigned individual tasks within scope
Ability to follow detailed policies, guidelines, and regulatory requirements
Verbal & Written Communication

Skills

Basic knowledge of Medicare Secondary Payer (MSP) rules and Other Health Insurance (OHI) processing
Knowledge of medical terminology

Benefits

We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program.

Pay

A good faith estimate of the current pay range is $19.45 - $27.23.

Schedule

The position is eligible for an annual incentive bonus (variable depending on company and employee performance).