Team Lead, Coordination of Benefits (COB) Jefferson Health Plan

Job Details

Job Description

• Leads and oversees a team of COB Analysts providing daily direction coaching and performance oversight. Manages COB inventory prioritization balancing value risk timeliness and regulatory requirements to ensure optimal use of internal and external resources.
• Serves as a subject matter expert on Coordination of Benefits including application of CMS Medicare Secondary Payer (MSP) rules and NAIC commercial COB guidelines.
• Reviews complex or escalated COB cases providing guidance on coverage determinations primacy decisions and downstream claim impacts. Provides oversight of external TPL vendors including monitoring performance validating outputs resolving issues and ensuring alignment with internal COB policies and workflows.
• Oversees quality review of COB work to ensure accuracy consistency and compliance with regulatory and internal standards. Develops maintains and analyzes COB operational reports to deliver data-driven insights on productivity inventory aging quality and financial impact. Identifies and implements process improvements informed by reporting trends to improve efficiency reduce rework and enhance COB outcomes.

Required Education and Experience:

• High School Diploma/GED with relevant experience.
• 5 years of experience in healthcare insurance operations including hands-on experience with Coordination of Benefits (COB) and/or Third-Party Liability (TPL) with demonstrated application of CMS Medicare Secondary Payer (MSP) rules and NAIC commercial COB guidelines.
• 2 years of experience in a lead supervisory or team oversight role including responsibility for inventory prioritization quality review staff performance and coordination with internal stakeholders or external vendors.
• Advanced knowledge of Coordination of Benefits and Third-Party Liability operations including application of CMS Medicare Secondary Payer (MSP) rules and NAIC commercial COB guidelines to support accurate benefit primacy determinations.
• Strong leadership and operational management skills with demonstrated ability to prioritize inventory oversee vendor performance manage team outcomes and drive accountability in a production environment.
• Ability to analyze operational and financial data to generate actionable insights inform decision-making identify trends and implement process improvements.

Preferred Qualifications

• Bachelors Degree in Healthcare Administration Business Finance or a related field.
• Experience working with SQL-based relational databases or querying tools to support reporting data analysis or operational insights preferred.

Work Shift

Worker Sub Type

Employee Entity

Primary Location Address

Nationally ranked Jefferson which is principally located in the greater Philadelphia region Lehigh Valley and Northeastern Pennsylvania and southern New Jersey is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65000 people strong dedicated to providing the highest-quality compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrows professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic clinical and applied research. Thomas Jefferson University home of Sidney Kimmel Medical College Jefferson College of Nursing and the Kanbar College of Design Engineering and Commerce dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8300 students. Jefferson Health nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age race color religion creed sexual orientation gender gender identity marital status pregnancy national origin ancestry citizenship military status veteran status handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues including medical (including prescription) supplemental insurance dental vision life and AD&D insurance short- and long-term disability flexible spending accounts retirement plans tuition assistance as well as voluntary benefits which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues including those who work less than part-time(including per diemcolleagues adjunct faculty and Jeff Temps) have access to medical (including prescription) insurance.

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