Claims COB Analyst

Where compassion meets innovation and technology and our employees are family.

GENERAL PURPOSE OF JOB:

Coordination of Benefits (COB) is the process of determining which of two or more insurance companies will have the primary responsibility of payment and the extent to which the other policies will contribute to the overall payment. The Claims COB Analyst performs claims analysis, research and validation, and associated responsibilities in support of the correct handling of claims involving other insurance coverage. The position additionally serves as a subject matter expert regarding COB-related policies and procedures.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Individuals in this position may perform any or all of the below listed duties. These should be interpreted as examples of the work and are not necessarily all-inclusive.

• Analyze members with other insurance coverage to determine the correct order of benefits.
• Audit claims to identify services paid as primary in error.
• Analyze COB claims to determine the correct claim payment.
• Research and validate other insurance coverage with insurance carriers.
• Support vendor oversight of COB recovery-related activities.
• Coach/mentor team members regarding opportunities for identification of COB.
• Effectively prioritize and complete all assigned tasks within appropriate timeframes and with the required level of quality.
• Openly participate in team meetings, providing ideas and suggestions to ensure departmental efficiency and quality, and to promote teamwork.
• Maintain required compliance with privacy and confidentiality standards.
• Maintain or exceed all established standards for performance, quality and timeliness.
• Support the Claims department in review, investigation, and research of claims issues.
• Demonstrate business practices and personal actions that are ethical and adhere to all Health System and Health Plan policies and procedures.
• Assist with other related work responsibilities as requested.

EDUCATION AND/OR EXPERIENCE:

• Minimum three years of professional experience in claims analysis, provider medical billing, or medical coding; experience with Texas Medicaid preferred.
• Minimum two years of professional experience with Coordination of Benefits, including order of benefit determination and payment calculation; experience with Texas Medicaid preferred
• Minimum High school graduate or GED required.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Experience with Microsoft Office, specifically Excel and Word
• Strong critical thinking and analytical skills with the ability to collect, organize, analyze, and disseminate information with attention to detail and accuracy
• Ability to effectively communicate, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques.
• Ability to work independently, or in a team environment, toward meeting common goals
• Ability to multi-task and meet deadlines in a fast-paced environment
• Ability to access data in varied formats with different methods of analyzing and processing data
• Integrity and discretion to maintain confidentiality of member and provider data
• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. 
• Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
• Ability to calculate figures and amounts such as discounts, interest, proportions, percentages, and aging.