Coordination of Benefits Specialist

About the role

Are you experienced in Coordination of Benefits (COB), Medicare, insurance verification, healthcare claims, or medical billing? We're looking for a detail-oriented healthcare professional who enjoys solving complex insurance coverage issues and working in a fast-paced remote environment.

Responsibilities

• Investigate and determine the correct Coordination of Benefits (COB) for members with multiple health insurance plans.
• Review insurance eligibility, policy coverage, and documentation to verify the proper payer order.
• Contact insurance carriers, Medicare (CMS), employer groups, healthcare providers, and members by phone, email, fax, and mail to validate coverage information.
• Research complex healthcare eligibility issues and apply Medicare CMS and NAIC guidelines to determine primary and secondary coverage.
• Document findings accurately in company systems while maintaining complete and detailed records.
• Review Explanation of Benefits (EOBs) and other insurance documentation to support payment determinations.
• Process incoming COB correspondence and updating eligibility records as needed.
• Handle inbound and outbound calls related to Coordination of Benefits inquiries.
• Maintain HIPAA compliance and adhere to all federal, state, and client requirements.
• Collaborate with teammates while working independently in a remote environment.
• Identify opportunities to improve processes, documentation, and communication.

Requirements

• Minimum of 2 years of healthcare experience involving Coordination of Benefits (COB) in a provider, payer, or healthcare vendor environment OR 4+ years of experience in one or more of the following: Insurance Verification, Medical Billing, Healthcare Claims Processing, Claims Auditing, Medical Reimbursement, Healthcare Data Analysis.
• Working knowledge of Coordination of Benefits (COB) guidelines.
• Knowledge of Medicare (CMS) regulations and NAIC Coordination of Benefits guidelines.
• Understanding of medical terminology and healthcare eligibility processes.
• Strong investigative, research, and critical thinking skills.
• Excellent verbal and written communication skills.
• Ability to explain complex insurance information clearly and professionally.
• Strong customer service skills with the ability to communicate confidently with insurance carriers, providers, employer groups, and members.
• Experience working in a production-driven environment while maintaining high-quality standards.
• Strong organizational and multitasking abilities.
• Proficiency with Microsoft Office (Word, Excel, and Outlook).
• Ability to work independently while collaborating effectively with a remote team.

Qualifications

• High school diploma or equivalent.
• Valid driver’s license and reliable transportation.

Skills

• Coordination of Benefits (COB)
• Medicare (CMS) regulations
• NAIC Coordination of Benefits guidelines
• Medical terminology
• Research and critical thinking
• Verbal and written communication
• Customer service
• Independent work
• Remote collaboration

Benefits

• Competitive starting pay
• Flexible Monday-Friday schedule
• No weekends required
• Eligible for benefits day 1
• Collaborative team environment

Pay

Starting at $20.00/hour (based on experience), which may be below your state's minimum wage. Please take this into consideration when applying.

Schedule

Monday-Friday | 9:00 AM - 5:30 PM EST

Location

Fully Remote