Coordination of Benefits Validation Specialist II

Job Summary

The Coordination of Benefits (COB) Validation Specialist ensures the accurate coordination of healthcare benefits for individuals covered under multiple insurance plans. The role involves validating coordination of benefits data, identifying discrepancies, and resolving issues to optimize benefit utilization and minimize costs. The COB Validation Specialist collaborates closely with various stakeholders, including insurance carriers, healthcare providers, and clients to ensure seamless coordination of benefits processing. The COB Validation Specialist conducts outbound calls to members and health plan carriers to validate coordination of benefits information. The Specialist proactively identifies, documents, investigates, and resolves COB issues in a timely and appropriate manner.

Duties

Stakeholder Communication - Facilitate timely outreach and serve as a liaison between insurance carriers, healthcare providers, clients, and internal teams to facilitate effective communication and resolution of coordination of benefits issues. Provide guidance and support regarding coordination of benefits rules, coverage options, and claim submission processes. Conduct outbound calls to members and health plan carriers covered under multiple insurance plans to validate coordination of benefits information. (50%)

Data Validation - Review and validate coordination of benefits data, including insurance policies, coverage details, and claims information. Identify discrepancies and inconsistencies in coordination of benefits data through meticulous analysis and verification. (15%)

Discrepancy Resolution - Investigate and resolve discrepancies in coordination of benefits data, including overlapping coverage, duplicate claims, and payment responsibility conflicts. Collaborate with insurance carriers, healthcare providers, and clients to address discrepancies and ensure accurate billing and reimbursement. (15%)

Quality Assurance - Conduct quality assurance checks to ensure compliance with coordination of benefits regulations, policies, and procedures. Review documentation and reports for accuracy and completeness, making necessary corrections or adjustments as needed. (10%)

Perform other duties as assigned. (10%)

Duties Continued

Education Required

Education Preferred

Experience

Required:

1 year of experience in healthcare insurance coordination, claims processing, or data validation.

Experience in Customer Service.

Preferred:

3 years of office experience in Managed Health Care.

Skills

Required:

Solid understanding of standard claims processing, COB guidelines and data analysis.

Must have knowledge of HMO, PPO, EPO, POS, Government Funded, Medicare and Medicaid plans.

Ability to effectively prioritize and meet deadlines while managing multiple competing tasks.

Must have strong analytical skills.

Ability to work effectively with diverse team members and key internal and external stakeholders. 

Excellent communication and interpersonal skills for effective collaboration with stakeholders at all levels.

Detail-oriented with a focus on accuracy and thorough documentation.

Ability to work independently and prioritize tasks in a fast-paced environment.

Proficient with Windows, Microsoft Office programs, and Outlook.

Preferred:

Must be familiar with coordinating benefits between health plan payers.

Knowledge of healthcare insurance regulations and coordination of benefits guidelines.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information