Payment Accuracy COB Specialist

Overview

We are representing a confidential healthcare analytics organization in their search for a Payment Accuracy Coordination of Benefits Specialist. This role is central to a specialized business unit that reviews health plan coverage scenarios where individuals are covered by multiple insurance plans. You'll analyze claims and member data to identify recoverable amounts, determine the correct order of liability, and deliver measurable results for our client's customers.

Working under supervision, you'll leverage proprietary audit platforms to conduct member investigations, document findings with precision, and support the claim recovery lifecycle from initial discovery through dispute resolution.

Responsibilities

• Apply Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to determine liability order accurately
• Conduct thorough member investigations using proprietary recovery management and tracking systems
• Create detailed, accurate documentation in audit platforms and client tools throughout each investigation
• Meet or exceed production and quality standards as defined by compliance, regulatory guidelines, and management
• Prepare and evaluate responses to client disputes both internally and externally
• Classify errors and overpayments to identify recovery opportunities for healthcare clients
• Identify continuous improvement opportunities for reporting efficiencies and streamlined research processes
• Ensure confidentiality and security of all data in full compliance with HIPAA laws and requirements
• Integrate information from multiple sources, consider broader context, and test promising ideas
• Complete special projects and other duties as assigned

What We're Looking For

• Education: High school diploma required; bachelor's degree preferred
• Experience: Minimum one year of related healthcare experience; Coordination of Benefits knowledge preferred
• Computer proficiency including Microsoft Office (Word, Excel, Outlook)
• Excellent verbal and written communication skills
• Enthusiasm for working with large datasets and diverse databases
• Ability to thrive in both individual and team environments with strong self-motivation
• Analytical skills: Ability to analyze large volumes of data, identify trends, discrepancies, and anomalies with exceptional attention to detail
• Critical thinking: Strong problem-solving abilities to assess complex situations, identify key issues, and propose practical solutions
• Decision-making: Ability to make informed decisions based on available data, regulations, and auditing standards
• Regulatory knowledge: Understanding of auditing standards, regulations, and industry best practices
• Physical requirements: Ability to sit or stand for prolonged periods with repetitive wrist, hand, and finger motions
• Remote work capability: Dedicated, secure work area with high-speed internet access

How We Work with You

Candidates apply directly through Get A Job.ai. Our talent team will conduct an initial screening to assess your qualifications and fit for this role. Once we've completed our evaluation, we'll submit qualified candidates to our client for consideration. Please do not attempt to contact the client organization directly, as all communications and submissions are managed exclusively through our recruiting process.

Pay

This position is classified as nonexempt and eligible for overtime pay. Compensation and benefits details will be discussed during the screening process with our team.

Equal Employment Opportunity: Get A Job.ai is committed to providing equal employment opportunities to all applicants and works with client organizations that share similar values. We evaluate candidates based on qualifications, skills, and experience without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other legally protected characteristic.