COB Specialist

Responsibilities

COB Specialist I

Researches and responds to inquiries/issues to ascertain specifics of multiple health insurance coverages for members and dependents. Contacts membership, providers, and other insurance companies to gather coordination of benefits (COB) data. Determines source of problem, impact to customers, and resolution.

* Generates reports in various systems to access daily inventory.

* Identifies and determines appropriate conditions to apply.

* Researches, resolves, and responds to moderately complex and time sensitive inquiries using both internal and external systems.

* Reviews and approves appropriate payment order for customer service inquiries routed to the Coordination of Benefits (COB) department for investigation and file update.

* Reviews and approves appropriate payment order for claims pended to the Coordination of Benefits (COB) department for investigation and file update.

* Maintains member COB files from returned correspondence/questionnaires.

* Participates in departmental meetings and assists in the development of workflow and process improvements.

* Answers phone inquiries regarding COB from internal customers such as customer service, operations, and other insurance companies.

* Performs other duties as assigned.

Sr. COB Specialist

Performs research to ascertain specifics of other coverage for members and dependents via correspondence and/or direct communication with members, other insurers, providers, sales representatives, Membership and other internal departments. Applies knowledge of regulations pertaining to order of benefit determination. Loads member files with the appropriate coding to reflect accurate status for a given time period.

* Reviews claims pended to the Coordination of Benefits (COB) department for investigation and file update.

* Researches and responds to Contact Online Reporting System (CORS).

* Maintains member COB files from returned correspondence/questionnaires.

* Answers COB phone lines.

* Performs additional research as necessary (ad hoc letters, phone calls) to assure complete and accurate file maintenance per member.

* Updates member files from monthly production maintenance reports and/or ad hoc query reports for group specific issues.

* Performs other duties as assigned.

Qualifications

COB Specialist I

Education and Experience:

* Bachelors' Degree in Business or Healthcare Administration or related field preferred, but will consider collective experience, training and education.

* 3 years of relevant experience in health insurance or the health care industry.

Technical Skills and Knowledge:

* Knowledge of health insurance products and services, benefits.

* Intermediate Microsoft Office and document workflow management systems skills.

Sr. COB Specialist

Education and Experience:

* Bachelors' Degree in Business or Healthcare Administration or related field preferred, but will consider collective experience, training and education.

* 1 year experience as a COB Specialist or equivalent 3 years experience in health insurance claims or customer service operations.

Professional Certification(s):

* Certified Professional Coder (preferred)

Technical Skills and Knowledge:

* Knowledge of National Association of Insurance Commissioners (NAIC) and Ohio Department of Insurance (ODI) Rules of Order, ASO requirements and COBRA, Medicare and Medicaid rules.

* Strong Knowledge of COB concepts and company policies related to COB administration.

* Intermediate to advanced Microsoft Office and internal systems (TOPPS OnBase, Membership?) skills.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.