Member Financial Specialist – Eligibility & COB

About the role

The Member Financial Specialist - Eligibility & COB supports accurate financial operations and enhances the member experience by resolving COB denials, addressing eligibility challenges, and ensuring insurance information is accurate and up-to-date. This role collaborates with members, insurance carriers, and internal teams to resolve coverage discrepancies and streamline claims processing.

Responsibilities

• Investigate and resolve COB denials by working directly with insurance carriers and members to identify and correct coverage issues.
• Conduct outreach to members to collect, verify, and update insurance information while providing clear guidance on benefits, coverage, and next steps.
• Maintain accurate member account records by documenting verified insurance details, coverage changes, and financial responsibility updates.
• Review and process documentation related to coverage updates, COB forms, payer communications, and eligibility changes.
• Analyze eligibility, coverage, and denial trends through routine and ad-hoc reporting to identify opportunities for process improvements.
• Interpret data reports and use insights to support targeted outreach and improve claims accuracy.
• Communicate professionally and empathetically with members and insurance organizations through phone, video, and written correspondence.
• Perform additional responsibilities as needed to support evolving business priorities.

Requirements

• Bachelor’s degree or an equivalent combination of education and relevant professional experience.
• Minimum of 2 years of experience in patient access, financial counseling, utilization management, or a related healthcare support function.
• Previous experience discussing insurance coverage, benefits, and financial responsibilities directly with patients.
• Familiarity with telehealth workflows and remote healthcare environments.
• Experience communicating with insurance payers and navigating commercial, Medicare, and Medicaid plans, particularly within behavioral health or SUD services.
• Experience using healthcare technology platforms such as EMRs, revenue cycle management systems, ticketing platforms, and Microsoft Office or Google Workspace tools.
• Strong analytical skills with the ability to interpret data, identify trends, and support operational decisions.
• Excellent communication skills with the ability to interact professionally, clearly, and with cultural sensitivity.
• Highly organized, adaptable, and capable of managing multiple priorities in a fast-paced environment.
• Comfortable working independently, exercising sound judgment, and handling sensitive information with professionalism and discretion.
• Quick learner who can understand new insurance plans, payer processes, and internal systems efficiently.

Benefits

• Competitive hourly compensation ranging from $19.05 to $25.16 per hour.
• Opportunity to work in a purpose-driven healthcare environment focused on improving access to care.
• Remote work flexibility with the ability to support members from a virtual setting.
• Exposure to healthcare operations, insurance processes, and innovative approaches to improving patient financial experiences.
• Collaborative workplace culture focused on teamwork, continuous improvement, and meaningful impact.
• Opportunities to develop expertise in eligibility, benefits coordination, and healthcare financial operations.