Member Financial Specialist – Eligibility & COB

Responsibilities

• Investigate and resolve COB denials by communicating directly with insurance carriers and members
• Conduct outreach to members to gather and update insurance details, verify coverage, and provide education on next steps
• Support special projects related to eligibility changes, contract updates, and coverage transitions
• Accurately update member accounts with verified insurance data, and notify members of any changes in benefits or financial responsibilities
• Perform routine and ad-hoc reporting to identify trends in COB denials, eligibility issues, and coverage discrepancies
• Run, interpret, and act on data reports to support operational improvements and targeted outreach
• Communicate professionally with members and insurance companies via phone, video, and written correspondence
• Review and process documents related to coverage updates, COB forms, and payer communications
• Maintain a strong understanding of insurance policies, benefits structures, and patient responsibility guidelines

Qualifications

• Mission-driven: You are deeply invested in patient success and committed to advancing the organization’s mission
• Strong communicator and culture-bearer: You represent the organization’s values in every member interaction and communicate clearly, confidently, and with cultural sensitivity
• Adaptable in fast-paced environments: You thrive in dynamic settings and can respond quickly to member needs
• Collaborative: You excel at building strong relationships across teams and working toward shared goals
• Data-savvy: You enjoy using data to evaluate performance and inform decision-making
• Innovative thinker: You can challenge the status quo and propose creative, practical solutions
• Highly organized: You manage multiple priorities and moving pieces with precision and consistency
• Flexible and resourceful: You navigate ambiguity and rapid change with ease and professionalism
• Self-directed: You are comfortable working independently and exercising sound judgment
• Technologically proficient: Comfortable operating an EMR, RCM and Microsoft Office/Google Products
• Able to use video conferencing platforms and ticketing systems
• Able to operate effectively in a remote environment
• Quick learner: Able to rapidly understand new insurance plans, payer processes, and internal tools
• Professional discretion: You handle sensitive information responsibly and ethically
• Compliance: Understand and adhere to the organization’s Code of Conduct