Coordination of Benefits (COB) Analyst Jefferson Health Plan

Job Details

Job Description

• Conducts outbound and inbound outreach as needed to members providers employers or other insurers to obtain validate or clarify other insurance. coverage information in support of COB determinations. Reviews member eligibility and coverage information to identify overlapping insurance coverage.
• Determines the correct order of benefits between payers in accordance with CMS Medicare Secondary Payer (MSP) rules and NAIC commercial Coordination of Benefits guidelines.
• Performs moderate to complex COB investigations involving multiple coverages conflicting data or overlapping eligibility periods. Accurately updates COB and coverage records in core systems to support proper claims routing and adjudication. Initiates claim reprocessing cost avoidance or recovery actions when COB determinations impact previously processed claims.
• Responds to COB-related claim appeals inquiries and research requests by reviewing coverage determinations and supporting documentation.
• Documents investigation findings clearly and thoroughly while meeting established productivity quality and timeliness standards.

Minimum Qualifications

• High School Diploma/GED with relevant experience required
• 2 years of experience in healthcare insurance operations such as COB TPL claims processing enrollment or payment integrity required
• Associates Degree in healthcare related field or Bachelors Degree in healthcare related field 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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