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eCOB Specialist I/II/III - Rem...

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Job Summary

Company
Anthem
Location
Atlanta, GA
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS4629

eCOB Specialist I/II/III - Remote in these locations: Atlanta or Columbus, GA-Indianapolis, IN-Lo...

About the Job

Description
Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

eCOB Specialist I/II/III

This offers the opportunity to work remotely specifically from the following locations:

Atlanta, GA
Columbus, GA
Indianapolis, IN
Louisville, KY
Mason, OH
Worthington, OH
Richmond, VA
Virginia Beach, VA

Responsible for researching and investigating other coverage for all of the company's groups and member 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. Primary duties may include, but are not limited to:

  • Utilizes internal queries, internal resource tools, must initiate delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS and Medicaid and report 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/groups Anthem 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.
  • Associate must identify the correct formulas in order to adjudicates 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.
Qualifications

Qualifications:

  • Requires a HS diploma or equivalent
  • 3 years of claims processing and customer service skills and 3 years COB experience that required using NAIC & CMS COB guidelines;

    • or any combination of education and experience, which would provide an equivalent background.

  • COB and/or CMS experience required

  • Knowledge in Medicare or experience in Medicare conceptions

Assets:

  • Knowledge of WGS preferred

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

 

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