COB Senior Analyst
COB Senior Analyst
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Job Description
This Claims Coordination of Benefits Analyst Payment Integrity serves as a strategic subject matter expert responsible for leading complex coordination of benefits initiatives that directly support the organizations payment integrity and cost containment goals. This role provides consultative guidance on COB policies oversees advanced claim analysis and develops data-driven strategies to prevent and recover improper payments due to COB errors.
As a senior contributor the Consultant partners with cross-functional teamsClaims Operations Payment Integrity Provider Relations Subrogation and Complianceto drive improvements in COB accuracy payer liability determinations and recovery outcomes. This position plays a key role in system enhancements regulatory interpretation vendor oversight and audit readiness with an emphasis on delivering measurable financial impact.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Serve as a COB and payment integrity SME for internal teams and external partners
Lead the identification and resolution of systemic COB issues causing payment inaccuracies
Design and execute COB analytics to uncover trends root causes and recovery opportunities
Interpret and apply CMS ERISA NAIC and Medicare Secondary Payer (MSP) regulations
Collaborate with PI teams on pre-pay edits post-pay audits and overpayment recovery initiatives
Provide guidance on EDI standards (/271) and payer hierarchy configuration
Support development and implementation of COB-related policy procedure and system changes
Mentor junior analysts and support training and knowledge transfer across departments
Prepare and present business cases and financial impact analyses to leadership
Assist in developing process documentation related to COB workflows
Assist leadership in developing and tracking key performance indicators
Assist with COB research and recovery projects
Work adhering to US regulatory and Quality System requirements (21 CFR 820 etc).
This position assumes and performs other duties as assigned.
QUALIFICATIONS
To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
Core qualifications:
3-5 years In-depth understanding of COB processes claim adjudication and payer coordination rules
Proven experience supporting or working within a Payment Integrity department
Strong investigative and data analysis skills including use of Excel and SQL
Familiarity with claims platforms (e.g. HealthEdge Facets QNXT) and EDI data structures
Strong communication skills for cross-functional collaboration and executive reporting
Preferred qualifications:
58 years in COB claims analysis or payment integrity roles within a payer environment
Strong knowledge of federal and state regulations affecting COB and improper payment recovery
Experience supporting audits SIU reviews or regulatory compliance related to COB
Experience with pre-pay and post-pay integrity controls audit response and provider recovery
Working knowledge of CARCs RARCs and overpayment recovery workflows
Advanced analytical skills (Excel SQL Tableau or similar tools)
EDUCATION and/or EXPERIENCE
Associates degree (A. A.) or Bachelors degree (B. A.) from four-year college or university; or three to five years experience relating to qualifications listed above.
Required Experience:
Senior IC
Employment Type
Full-Time
