Coordination Of Benefits Specialist

Our client provides mission-critical healthcare services and solutions to Fortune 100 companies and over 500 government entities. Operating within the healthcare insurance and benefits space, the organization helps manage complex claims, insurance coverage, and benefits coordination, supporting accurate claims processing and compliance with Medicare and federal regulations.

About the Role

The Coordination of Benefits Specialist investigates and resolves healthcare claims for members with multiple insurance plans. This role determines the correct order of benefits, verifies eligibility and coverage, and communicates with insurance carriers, Medicare, employers, healthcare providers, and members to ensure accurate claims processing. The ideal candidate has experience in healthcare claims, insurance verification, billing, or Coordination of Benefits and is comfortable working independently in a remote, production-focused environment.

Responsibilities

• Investigate and determine the appropriate Coordination of Benefits (COB) for members covered by multiple insurance plans.
• Review insurance eligibility, policies, and coverage information to establish the correct payer order.
• Communicate with insurance carriers, Medicare, employers, providers, and members to validate coverage and resolve discrepancies.
• Research complex eligibility and coverage issues using applicable Medicare and NAIC COB guidelines.
• Review Explanation of Benefits (EOB) statements and other insurance documentation to support accurate payment and claims decisions.
• Process incoming COB correspondence and update member eligibility records accordingly.
• Document research findings, decisions, and communications accurately and maintain complete records.
• Handle inbound and outbound calls related to Coordination of Benefits inquiries.
• Meet established productivity, quality, accuracy, and turnaround-time expectations.
• Maintain compliance with HIPAA and applicable federal, state, and client requirements.
• Collaborate with team members and internal stakeholders while independently managing assigned work.
• Identify opportunities to improve processes, documentation, workflows, and communication.

Requirements

• Minimum of 2 years of healthcare experience involving Coordination of Benefits in a provider, payer, or vendor environment; or 4+ years of experience in insurance verification, medical billing, claims processing, auditing, reimbursement, or healthcare data analysis.
• Working knowledge of Coordination of Benefits guidelines and procedures.
• Familiarity with Medicare CMS regulations and NAIC COB guidelines.
• Understanding of medical terminology, insurance eligibility, and claims processes.
• Strong research, analytical, critical-thinking, and problem-solving skills.
• Excellent verbal and written communication skills.
• Ability to explain complex insurance and benefits information in a clear, understandable manner.
• Strong customer service skills when communicating with insurance carriers, providers, employers, and members.
• Experience maintaining accuracy and quality in a production-driven environment.
• Strong organizational and multitasking abilities.
• Proficiency with Microsoft Word, Excel, and Outlook.
• Ability to work independently while collaborating effectively with a remote team.

Pay

Starting pay of $20.00 per hour, based on experience. Estimated annual salary range of approximately $39,960–$46,200. Potential eligibility for bonus or incentive compensation based on business needs.

Benefits

• Health insurance coverage.
• Voluntary dental and vision programs.
• Life and disability insurance.
• 401(k) retirement savings plan.
• Paid holidays.
• Paid time off, vacation, and/or sick leave.
• Fully remote position.
• Flexible Monday–Friday schedule.
• No weekend work.