Elevance Health
eCOB Specialist III
Elevance Health, South Portland, Maine, us, 04106
Elevance Health eCOB Specialist III SOUTH PORTLAND, Maine Apply Now
Location : Hybrid, within 50 miles of an Elevance Health pulse point.Hours:
Monday - Friday, an 8 hour shift between 6 am - 6 pmThe
eCOB Specialist III
is responsible for researching and investigating other coverage for all of the company's groups and members on multiple platforms. Fully proficient in all key areas; performs multi complex functions and interprets complex rules, laws, and contracts. Accountable for end-to-end functionality on every Coordination of Benefits (COB) function including reconciliation of claim, membership, and accounting.How you will make an impact:Utilizes internal queries, internal resource tools, must initiate delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS, and Medicaid to identify members who are or should be enrolled in other coverage.Aides members in enrolling in Medicare when they are entitled.Determines primacy on each case using a complex set of Primacy Rules as mandated by State and Federal Laws, such as CMS Primacy and NAIC rules and comparing them against the member/group Benefits.Updates all of the company's membership system components with investigation results for claim coordination.Ensures correct forms are provided to assist members enrolling in Medicare.Reviews claim history to identify claims requiring reconciliation, whether processed or pended, as well as recovered in error.Identifies the correct formulas to adjudicate impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines.Handles complex case research and resolution.May assist with training of new associates.Minimum Requirements:Requires a HS diploma or equivalent and a minimum of 3 years of claims processing and customer service experience, along with 3 years COB experience that required using NAIC & CMS COB guidelines; or any combination of education and experience which would provide an equivalent background.For candidates working in person or remotely in the below location(s), the salary range for this specific position is $21.77 to $39.19.Locations : California; New York;In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).Job Level:
Non-Management Non-ExemptWorkshift:
1st Shift (United States of America)Job Family:
CLM > Claims SupportPlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Who We Are:Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.How We Work:At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes, and drive our shared success - for our consumers, our associates, our communities, and our business.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state, and local laws.Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws.Join our Talent Community and stay connected with company news, information, and future job opportunities.
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Location : Hybrid, within 50 miles of an Elevance Health pulse point.Hours:
Monday - Friday, an 8 hour shift between 6 am - 6 pmThe
eCOB Specialist III
is responsible for researching and investigating other coverage for all of the company's groups and members on multiple platforms. Fully proficient in all key areas; performs multi complex functions and interprets complex rules, laws, and contracts. Accountable for end-to-end functionality on every Coordination of Benefits (COB) function including reconciliation of claim, membership, and accounting.How you will make an impact:Utilizes internal queries, internal resource tools, must initiate delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS, and Medicaid to identify members who are or should be enrolled in other coverage.Aides members in enrolling in Medicare when they are entitled.Determines primacy on each case using a complex set of Primacy Rules as mandated by State and Federal Laws, such as CMS Primacy and NAIC rules and comparing them against the member/group Benefits.Updates all of the company's membership system components with investigation results for claim coordination.Ensures correct forms are provided to assist members enrolling in Medicare.Reviews claim history to identify claims requiring reconciliation, whether processed or pended, as well as recovered in error.Identifies the correct formulas to adjudicate impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines.Handles complex case research and resolution.May assist with training of new associates.Minimum Requirements:Requires a HS diploma or equivalent and a minimum of 3 years of claims processing and customer service experience, along with 3 years COB experience that required using NAIC & CMS COB guidelines; or any combination of education and experience which would provide an equivalent background.For candidates working in person or remotely in the below location(s), the salary range for this specific position is $21.77 to $39.19.Locations : California; New York;In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).Job Level:
Non-Management Non-ExemptWorkshift:
1st Shift (United States of America)Job Family:
CLM > Claims SupportPlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Who We Are:Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.How We Work:At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes, and drive our shared success - for our consumers, our associates, our communities, and our business.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state, and local laws.Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws.Join our Talent Community and stay connected with company news, information, and future job opportunities.
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