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Role Description

The Electronic Coordinator of Benefit Specialist II is responsible for researching and investigating other coverage for all of the company's groups and members on multiple platforms. Fully proficient in all key areas; performs 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.

How you will make an impact:

• Utilizes internal queries and resource tools; initiates delicate phone calls to carriers, members, groups, providers, attorneys, CMS, and Medicaid to identify members who are or should be enrolled in other coverage.
• Aides members in enrolling in Medicare when they are entitled.
• Determines primacy on each case using a complex set of Primacy Rules as mandated by State and Federal Laws, such as CMS Primacy and NAIC rules.
• 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 identify claims requiring reconciliation, whether processed or pended, as well as recovered in error.
• Identifies the correct formulas to adjudicate impacted claims, using multiple COB Formulas for various product types, pursuant to State and Federal Guidelines.
• Handles calls, texts, facsimiles, and electronic queues while simultaneously taking notes and speaking to customers.
• Maintains focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment.
• Demonstrates strong verbal and written communication skills, both with virtual and in-person interactions.
• Exhibits attention to detail, critical thinking, and problem-solving skills.
• Demonstrates empathy and persistence to resolve caller issues completely.
• Comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
• Structured work schedule with occasional overtime or flexibility based on business needs.
• Performs other duties as assigned.

Qualifications

• Requires a HS diploma or equivalent.
• Minimum of 2 years of claims processing and customer service experience.
• 2 years COB experience that required using NAIC & CMS COB guidelines.
• Any combination of education and experience which would provide equivalent experience.

Requirements

• Ability to multi-task in a fast-paced environment.
• Strong verbal and written communication skills.
• Attention to detail and critical thinking abilities.
• Empathy and persistence in resolving issues.
• Comfort with digital tools and platforms.

Benefits

• Market-competitive total rewards including merit increases.
• Paid holidays and Paid Time Off.
• Incentive bonus programs.
• Medical, dental, and vision benefits.
• Short and long-term disability benefits.
• 401(k) with match.
• Stock purchase plan.
• Life insurance.
• Wellness programs and financial education resources.