Anthem, Inc. eCOB Specialist III in Melville, New York
SHIFT: Day Job
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 at one of America's leading health benefits companies and a Fortune Top 50 Company.
Given Anthem’s scale, balance sheet, broad national reach and depth at the local market level, Anthem has established a new business unit called the Diversified Business Group. The Diversified Business Group is a solutions-oriented business unit within the Company that will support Anthem and other external clients in the pursuit of transforming healthcare.
The eCOB Specialist I/II/III is responsible for researching and investigating other coverage for all of the company's groups and members; performing 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, membersgroups, 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
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.
Excellent oral and written communication skills and skill in using PC, database system, and related software (word processing, spreadsheets, etc.).
Must have knowledge and experience with WGS platform
Must have knowledge and experience with Legacy CS90
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.