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eCOB Specialist I,II,III- Georgia, Indiana, Ohio, Kentucky, VirginiaLocation: Georgia, United StatesNewRequisition #: PS22333Your 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 atone of America's leading health benefits companies and a Fortune Top 50 Company.The level chosen for this position will be based on the applicant's experience and qualification. These positions can be located in Georgia, Indiana, Ohio, Kentucky, or Virginia.The eCOB Specialist 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.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.
Level I:
Requires a HS diploma or equivalent.
At least 1 year of customer service experience required.
At least 1 year coordination of benefits experience preferred.
WGS and/or NASCO experience preferred.
Knowledge of NAIC and CMS COB guidelines preferred.
Excellent oral and written communication skills and skill in using PC, database system, and related software (wordprocessing, spreadsheets, etc.) or any combination of education and experience, which would provide an equivalent background.
Level II:
HS Diploma or GED.
At least 2 years of claims processing experience required.
At least 1 year of customer service experience required.
At least 1 year of coordination of benefits experience required.
WGS and/or NASCO experience required.
2 years coordination of benefits experience that required using NAIC & CMS COB guidelines determining primacy andprocessing experience on more than one of the company's platform preferred.
Excellent oral and written communication skills and skill in using PC, database system, and related software (wordprocessing, spreadsheets, etc.); or any combination of education and experience, which would provide an equivalentbackground.
Level III:
High school diploma or GED.
3+ years of claims processing and customer service skills.
WGS and/or NASCO experience required.
At least 3 years coordination of benefits experience that required using NAIC & CMS COB guidelines determining primacy andprocessing experience on more than one of the company's platform preferred.
Excellent oral and written communication skills and skill in using PC, database system, and related software (wordprocessing, spreadsheets, etc.); or any combination of education and experience, which would provide an equivalentbackground.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
