eCOB Specialist II - Anthem, Inc (California)
eCOB Specialist II (PS16355)
**Location:** **United States**
**Field:** Claims
**Requisition #:** PS16355
**Post Date:** 6 hours ago
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 atone of America's leading health benefits companies and a Fortune Top 50 Company.
The **eCOB Specialist I** is responsible for researching and investigating other coverage for all of the company's groups and members. 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.
+ 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 reconcile processed, pended or recovered in any 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.
The **eCOB Specialist II** 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.
**eCOB Specialist I**
+ Requires a HS diploma or equivalent; 1 year of claims processing and/or customer service skills and 1 year coordination of benefits experience; or any combination of education and experience, which would provide an equivalent background.
+ Requires knowledge of NAIC & CMS COB guidelines
+ Excellent oral and written communication skills and skill in using PC, database system, and related software (word processing, spreadsheets, etc.).
+ ACES systems experience strongly preferred
**eCOB Specialist II**
+ Requires a HS diploma or equivalent; 2 years of claims processing and customer service skills and 2 years COB experience that required using NAIC & CMS COB guidelines; or any combination of education and experience, which would provide an equivalent experience.
+ ACES systems experience strongly preferred
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